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Elbow grease: Lateral and medial condyle fractures of the humerus
Case presentation
A 4-year-old male presents with right elbow pain and swelling. He was playing on his school’s monkey bars when he fell, landing on his right arm and elbow. He fell approximately 3 feet. There was no reported loss of consciousness and the child immediately cried. He complained of elbow pain and was brought directly for evaluation.
The child is afebrile and has age-appropriate vital signs. He has no signs of trauma to his head. He has no neck or back pain, crepitus, swelling, or deformity and is ambulatory. He does not appear to have any injury to his shoulders or his left arm. He initially refuses to move his right arm at the elbow, which is swollen. With some coaxing, he has movement at the elbow but this is limited secondary to pain. There is not any upper arm, forearm, wrist, hand, or digit pain, swelling, or deformity. He is grossly neurovascularly intact.
Imaging considerations
Plain radiography
Anteroposterior (AP) and lateral views of the elbow are usually performed to evaluate for fracture. In general, these views will suffice but an internal oblique view is useful to assess the degree of displacement for condyle fractures. One study reported significant discrepancies between the apparent displacement of lateral condyle fracture fragments on AP and lateral views, compared to an internal oblique view. This study showed that a majority of fractures that were detected on AP and lateral views had a different degree of displacement and fracture pattern on an internal oblique view, and the authors recommended adding an internal oblique view to the AP and lateral views to assess lateral condyle fractures. , Internal oblique radiography has also been recommended by some authors at follow-up after initial two-view radiography, as useful for detecting displacement in initially nondisplaced or minimally displaced lateral condyle fractures.
As with lateral condyle fractures, two-view imaging of medial condyle fractures is usually utilized. Some have suggested utilization of internal oblique views in these fractures, although in another case series, the authors identified all fractures with AP and lateral views.
Medial epicondyle fractures are visualized with AP and lateral views. Oblique views, however, can help determine fracture fragment displacement and should be obtained.
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