Condylar fracture: Difference between revisions
(Expand: types, fat pad sign, pediatric lateral condyle pearl, management) |
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==Background== | ==Background== | ||
*Fracture of the distal humeral condyle at the elbow | |||
*More common in children (lateral condyle fracture is the second most common pediatric elbow fracture after [[supracondylar fracture]]) | |||
*In adults, usually from direct trauma or fall on outstretched hand | |||
*Types: lateral condyle, medial condyle, transcondylar, intercondylar (bicondylar) | |||
{{Proximal arm fracture DDX}} | {{Proximal arm fracture DDX}} | ||
==Clinical Features== | ==Clinical Features== | ||
*Elbow pain, swelling, ecchymosis | |||
*Inability or refusal to extend/flex elbow | |||
*Point tenderness over the affected condyle | |||
*Lateral condyle: tenderness over lateral elbow; may mimic lateral epicondylitis | |||
*'''Pediatric pearl:''' Lateral condyle fractures are frequently missed — can be subtle on plain films | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
*AP and lateral elbow x-rays — may require comparison views in pediatrics | |||
*'''Fat pad sign:''' Posterior fat pad (''sail sign'') indicates intra-articular fracture | |||
*CT if plain films equivocal and high clinical suspicion (especially intercondylar fractures in adults) | |||
*Assess neurovascular status: radial nerve (lateral condyle), ulnar nerve (medial condyle) | |||
==Management== | ==Management== | ||
{{General Fracture Management}} | {{General Fracture Management}} | ||
*'''Non-displaced (<2mm):''' Long arm splint at 90° flexion, orthopedic follow-up within 1 week with repeat imaging | |||
*'''Displaced (>2mm) or intra-articular:''' Orthopedic consult for operative fixation (ORIF) | |||
*'''Pediatric lateral condyle:''' Low threshold for orthopedic referral — displacement may progress; risk of nonunion, malunion, and cubitus valgus | |||
==Disposition== | ==Disposition== | ||
*Non-displaced: splint and outpatient orthopedic follow-up (3-5 days for pediatric lateral condyle) | |||
*Displaced or open: orthopedic consult from ED | |||
==See Also== | ==See Also== | ||
*[[Humerus fracture]] | *[[Humerus fracture]] | ||
*[[Supracondylar fracture]] | |||
*[[Medial epicondyle fracture]] | |||
*[[Distal humerus fracture]] | |||
==References== | ==References== | ||
Latest revision as of 01:47, 21 March 2026
Background
- Fracture of the distal humeral condyle at the elbow
- More common in children (lateral condyle fracture is the second most common pediatric elbow fracture after supracondylar fracture)
- In adults, usually from direct trauma or fall on outstretched hand
- Types: lateral condyle, medial condyle, transcondylar, intercondylar (bicondylar)
Humerus Fracture Types
Clinical Features
- Elbow pain, swelling, ecchymosis
- Inability or refusal to extend/flex elbow
- Point tenderness over the affected condyle
- Lateral condyle: tenderness over lateral elbow; may mimic lateral epicondylitis
- Pediatric pearl: Lateral condyle fractures are frequently missed — can be subtle on plain films
Differential Diagnosis
Elbow Diagnoses
Radiograph-Positive
- Distal humerus fracture
- Radial head fracture
- Capitellum fracture
- Olecranon fracture
- Elbow dislocation
Radiograph-Negative
- Biceps tendon rupture/dislocation
- Lateral epicondylitis
- Medial epicondylitis
- Olecranon bursitis (nonseptic)
- Pronator teres syndrome
- Septic bursitis
Pediatric
- Nursemaid's elbow
- Supracondylar fracture
- Lateral epicondyle fracture
- Medial epicondyle fracture
- Olecranon fracture
- Radial head fracture
- Salter-Harris fractures
Evaluation
- AP and lateral elbow x-rays — may require comparison views in pediatrics
- Fat pad sign: Posterior fat pad (sail sign) indicates intra-articular fracture
- CT if plain films equivocal and high clinical suspicion (especially intercondylar fractures in adults)
- Assess neurovascular status: radial nerve (lateral condyle), ulnar nerve (medial condyle)
Management
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
- Non-displaced (<2mm): Long arm splint at 90° flexion, orthopedic follow-up within 1 week with repeat imaging
- Displaced (>2mm) or intra-articular: Orthopedic consult for operative fixation (ORIF)
- Pediatric lateral condyle: Low threshold for orthopedic referral — displacement may progress; risk of nonunion, malunion, and cubitus valgus
Disposition
- Non-displaced: splint and outpatient orthopedic follow-up (3-5 days for pediatric lateral condyle)
- Displaced or open: orthopedic consult from ED