Lateral condyle fractures in children: Evaluation of classification and treatment

Objective: To compare intra-operative findings of fractures of the lateral condyle of the humerus in children with existing pre-operative radiographic classification. Design: Prospective, consecutive. Setting: Large urban hospital. Patients: 25 consecutive displaced lateral condyle (humerus fractures) in 25 children diagnosed on biplanar radiographs. Intervention: Open reduction and internal fixation through a lateral approach to the elbow. Main Outcome Measurements: Anatomic variations of the lateral condyle of the distal humerus based upon intra-operative observations; comparison of findings with pre-operative radiographic classification. Results: Three anatomic types were identified: 1) nine fractures exiled on the medial side of the capitellum in the capitello-trochlear groove (36%), 2) eleven fractures exited beyond the capitello-trochlear groove through the trochlear epiphysis (44%), and 3) five fractures extended across the physis medially (20%). No fracture appeared to transverse the ossified portion of the capitellum (Milch Type I). The Milch anatomic classification was found to be inaccurate in 52% of the fractures. Conclusion: Intraoperative findings did not correlate with the presumed preoperative radiographic diagnosis in the majority of cases. A heightened awareness of the limitations of this traditional classification system is required for operative decision.