Medial condyle fractures are less common than lateral condyle fractures in the pediatric elbow. However, medial fractures are more problematic with regards to treatment and outcome. The unossified elbow complicates the diagnosis and confuses the treatment algorithm. This report is a retrospective study of 21 patients. Diagnosis was obvious from plain films in the majority of patients, although 4 required advanced imaging techniques make the diagnosis. A variety of treatments were performed dependent upon fracture displacement. Immobilization alone was used in 11 patients, percutaneous pinning in 2 patients, and ORIF in 7 patients. Two children lost reduction after surgery and these children had substantial loss of motion. No infections or nerve injuries were reported. Average follow-up was 1 year and 11 children had full range of motion. Seven patients had mild residual loss of motion, primarily in flexion and extension. Patients with significant motion loss (3) sustained a medial condyle fracture associated with an elbow dislocation. One of these patients developed a nonunion.
This report highlights the necessity of accurate diagnosis in children with medial condyle fractures. Delineation of a displaced from non-displaced injuries is the key to guiding treatment. Immobilization of a non-displaced fracture will result in an excellent outcome with minimal sequelae. Displacement requires anatomic reduction to realign the joint surface and to prevent future problems, such as non-union and avascular necrosis.
Journal of Pediatric Orthopaedics