We don’t see many kids after they break an arm or leg. However, I have seen a few after they have broken their elbow. Elbow fractures can have complications, including stiffness. A lateral condyle fracture is no exception. Read on to learn about lateral condyle fractures and how to treat them.
The elbow
The elbow joint is where the humerus, ulna, and radius come together. The humerus is the upper arm bone and forms individual joints with the ulna and radius, which are the forearm bones. Movements of the elbow include flexion and extension. Flexion is when the forearm and upper arm come closer together (bending the elbow) and extension is when they move farther apart (straightening the elbow). The upper parts of the radius and ulna will also form a joint which allows for the movements of pronation and supination. Pronation is rotating the forearm, so the palm faces downward, and supination is forearm rotation where the palm faces upward.
At the elbow, there are two big bony bumps on either side of the joint. These are the epicondyles at the end of the humerus. Epicondyles are large bony prominences where the tendons of muscles and ligaments attach. There is a lateral epicondyle and a medial epicondyle. The epicondyles are attached to the sides of the lateral and medial condyles of the humerus. The condyles are the rounded, bony areas at the very end of the humerus. They attach to the ulna and radius to make the elbow joint.
What is a lateral condyle fracture?
The lateral condyle fracture is a break at the end of the humerus at the elbow. This is the second most common elbow fracture in kids. It tends to occur between the ages of 4-10 with the peak incidence at 6 years old. This fracture often goes through the growth plate. It can, also, extend to the end of the humerus where it connects to the ulna at the elbow joint.
This fracture is typically associated with a fall during sports or other play activities. The most common way to fracture the lateral epicondyle is to fall on an outstretched hand.
What are the symptoms of a lateral condyle fracture?
There are several symptoms associated with a lateral condyle fracture. These include:
- Pain in the elbow
- Swelling at the elbow, forearm, and hand
- Bruising at the elbow
- Limited movement of the elbow because it hurts
- There is often no obvious deformity at the elbow beyond swelling
Are there any potential complications with a lateral condyle fracture?
These fractures are prone to displacement because of the muscle attachments at the lateral epicondyle. This means that the piece of bone that is broken off of the humerus has a tendency to move. This is due to the wrist extensor muscle group that is attached to the lateral epicondyle. A forceful wrist extension movement (bringing the back of the hand towards the forearm) can cause these muscles to contract and pull the piece of bone out of position. This displacement can lead to multiple types of complications. These complications include:
- Elbow stiffness – This is the most common complication and is usually self-resolving. However, physical therapy can help if mobility is not improving.
- Delayed union – This indicates that it is taking longer than expected for the bones to heal but is expected to eventually heal without further medical intervention.
- Nonunion – This means that the fracture is not healing and there is little chance of it healing without surgical intervention.
- Growth disturbance – Because this fracture is through the growth plate, it can cause growth arrest to the injured area. Growth arrest causes abnormal bone growth meaning that it grows slower or not at all. This can lead to what is called a fishtail deformity at the elbow. This is not an obvious deformity at the elbow, unless seen on x-ray. However, it can lead to ongoing issues such as pain, difficulty using the elbow, and the development of early osteoarthritis.
- Avascular necrosis – This is caused by a lack of blood flow to an area of bone. This in turn causes that area of bone to die.
- Cubital varus or valgus – This is a misalignment of the elbow joint. It causes the forearm to be deviated more towards or away from the body when the elbow is straight.
- Overgrowth – A prominent lateral condyle or large, bony bump on the elbow could also occur. However, these don’t tend to cause any additional issues or affect overall recovery.
Will my child need surgery?
The answer is possibly. This type of fracture has a tendency to move. If the fracture is not displaced or is displaced less than 2mm, then a cast is applied for 4-6 weeks. If the fracture is displaced more than 2mm, then surgery will be needed so that the bones heal in the proper position.
Who should I see?
- Physician – If you suspect that your child has sustained a lateral fracture (or some other type of fracture), it is best to go to the emergency room. Because of the potential complications, this fracture should be treated quickly. However, if your fracture has already been treated and you suspect additional injury or complication, then it would be best to see your orthopedist, pediatrician, or primary care physician. Additional imaging and inspection might be needed to rule out other conditions.
- Physical therapist – Physical therapy might be needed if your child is having difficulty regaining strength and/or motion around the elbow. Kids usually do not need therapy because they tend to perform their own therapy by playing. My son broke his radius and ulna at the wrist when he was 5. He was able to regain full function and motion with little help from me. However, if stiffness or strength is not improving, then physical therapy can be very helpful. Your PT can evaluate your child to determine the extent of their deficits and use manual therapy, as well as, stretching, and strengthening to help address all problems in and around the elbow.
What can I do?
- Relative rest – Resting the area to decrease further pain and damage from occurring is one of the best ways to allow the bones to heal. If you are not able to participate in your activity or sport, then you can supplement with non-irritating activities such as walking, or jogging while your elbow is healing.
- Ice – Ice can help decrease pain and symptoms at the elbow. Ice the painful area for 15 to 20 minutes at a time. I would recommend using an ice pack several times per day if the pain is constant or is preventing you from participating in an activity. Ice immediately after activity.
- The following are activities that your child can do after the cast is removed or you are cleared by your surgeon.
- Elbow stretches – The elbow might have limited motion in certain directions. Typically, extension or straightening the elbow is the hardest to fully regain. However, depending on the person, then flexion, pronation, or supination might also be tight. See the video below in how to stretch the muscles around the elbow.
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- Wrist flexion and extension stretching – You will also need to stretch out the wrist flexors and extensors. These muscles attach at or near the elbow and could be tight. See the video below.
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- Strengthening the muscles around the elbow and wrist – Strengthening the muscles around the wrist and elbow are also important in being able to return to your activity. Decrease your resistance or number of repetitions if the pain is moderate to severe during the exercise or returns after the exercise. Using dumbbells or resistance bands can increase strength and difficulty. See the videos below.
In review
- The elbow joint is where the humerus, ulna, and radius come together.
- Movements of the elbow include flexion and extension.
- The upper parts of the radius and ulna will also form a joint which allow for the movements of pronation and supination.
- Epicondyles are large bony bumps where the tendons of muscles and ligaments attach.
- There is a lateral epicondyle and a medial epicondyle.
- The epicondyles are attached to the sides of the lateral and medial condyles of the humerus.
- The condyles are the rounded, bony areas at the very end of the humerus.
- They that attach to the ulna and radius to make the elbow joint.
- The lateral condyle fracture is a break at the end of the humerus at the elbow.
- It tends to occur between the ages of 4-10 with the peak incidence at 6 years old.
- This fracture often goes through the growth plate.
- Swelling, pain, and difficulty moving the elbow are symptoms of a lateral condyle fracture.
- There can be serious complications, so it is important to seek medical help when a fracture is suspected.
- Physical therapy will play a role if there is difficulty in regaining strength and mobility in the elbow.
- There are things your child can do once the cast is off or you are cleared by the surgeon.
- Ice
- Elbow stretches
- Wrist stretches
- Strengthening of the muscles around the elbow and wrist
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://posna.org/physician-education/study-guide/lateral-condyle-fractures