The radiograph demonstrates a laterally displaced and rotated intra-articular lateral condylar fracture, a Type III fracture. Type I fractures are non-displaced, stable fractures that may be treated with a long arm cast, but must be followed closely for possible displacement. Type II fractures are minimally displaced and may undergo attempted closed reduction with percutaneous pinning if the fracture is able to be anatomically reduced and found to be stable with stress arthrography. If anatomic reduction is not obtained, open reduction with internal fixation must be performed. Type III fractures are displaced, unstable fractures that require open reduction and fixation. Although there have been recent articles published recommending attempted closed reduction on all fractures, Rockwood & Wilkin's still recommends against closed reduction for Type III fractures because of the difficulty maintaining reduction of these fractures.
Launay et al found that immobilization alone resulted in additional displacement and more nonunions than did operative treatment and concluded that displaced fractures should be fixed surgically.
The Sullivan article is an overview of lateral condyle fractures.
Illustration A displays the classification system of I, II, & III from left to right.
Taping and Orthotics : It has been suggested that bracing (forearm straps and cock-up wrist splints) can redirect the extensor force vector and may provide symptom relief. The systematic review by Bisset et al. (2005) suggested that further research is required before any firm conclusions can be draw on the impact of taping/orthotics for lateral epicondylalgia. Whilst Jensen et al (2001) found considerable improvements when they compared an off the shelf orthotic (Rehband) with a CSI over 6 weeks, Wuori et al (1998) showed no benefit of counterforce bracing over sham bracing.
Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine; Clinical Professor of Surgery, Nova Southeastern School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture , American Academy of Orthopaedic Surgeons , American Orthopaedic Association , American Society for Surgery of the Hand , Arkansas Medical Society , Florida Medical Association , Florida Orthopaedic Society
Disclosure: Nothing to disclose.