LATERAL CONDYLE FRACTURES IN CHILDREN - EVALUATION OF CLASSIFICATION AND TREATMENT

Objective: To compare intra-operative findings of fractures of the lat eral condyle of the humerus in children with existing pre-operative ra diographic classification. Design: Prospective, consecutive. Setting: Large urban hospital. Patients: 25 consecutive displaced lateral condy le (humerus fractures) in 25 children diagnosed on biplanar radiograph s. Intervention: Open reduction and internal fixation through a latera l approach to the elbow. Main Outcome Measurements: Anatomic variation s of the lateral condyle of the distal humerus based upon intra-operat ive observations; comparison of findings with pre-operative radiograph ic classification. Results: Three anatomic types were identified: 1) n ine fractures exiled on the medial side of the capitellum in the capit ello-trochlear groove (36%), 2) eleven fractures exited beyond the cap itello-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 T ype I). The Milch anatomic classification was found to be inaccurate i n 52% of the fractures. Conclusion: Intraoperative findings did not co rrelate with the presumed preoperative radiographic diagnosis in the m ajority of cases. A heightened awareness of the limitations of this tr aditional classification system is required for operative decision.