II. Epidemiology

  1. Second most common elbow Fracture in children (12 to 17% of Distal Humerus Fractures)
  2. Most common elbow physeal Fracture
  3. Age of onset typically 4 to 7 years old

III. Mechanism

  1. Fall on an outstretched hand
  2. Avulsion Fracture of lateral condyle at attachment of the wrist extensors (and lateral collateral ligament)

IV. Signs

  1. Lateral Elbow Pain, swelling and decreased range of motion

V. Imaging

  1. See Elbow XRay
  2. Differentiate Fracture lines from normal Growth Plates
    1. See Elbow Ossification Centers
  3. Evaluate for Salter-Harris Fractures
    1. Fractures lines are often occult in non-displaced Fractures

VI. Management

  1. Initial Splinting
    1. Posterior splint with Forearm in neutral position and elbow at 90 degrees
  2. Definitive management
    1. Orthopedic referral in all cases
    2. Most cases require surgical management with ORIF
    3. Some non-displaced or minimally displaced Fractures may be managed with Casting
      1. Requires repeat XRay every 3-5 days for first 7-10 days to confirm Fracture remains nondisplaced
      2. Non-displaced Fractures can then be casted in a Long Arm Cast for 3 weeks

VII. Complications

  1. Rarely associated with neurovascular injury (contrast with supracondylar Fractures)
  2. Growth arrest
  3. Nonunion or malunion
    1. Cubitus varus deformity
    2. Cubitus valgus deformity
      1. Risk of Ulnar Nerve palsy

VIII. References

  1. Broder (2023) Crit Dec Emerg Med 37(6): 20-2
  2. Eiff (2012) Fracture Management for Primary Care, Saunders, Philadelphia, p. 265-6

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