Condylar fracture
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