This is the second most common fracture around the elbow joint, constituting 16.8% of all fractures of the distal humerus. The intraarticular extension of the fracture result in greater potential for elbow stiffness. Epiphyseal involvement makes growth disturbances more likely. The displacement which almost always occurs in this fracture makes operative treatment unavoidable. A poorly treated lateral condyle fracture may manifest with an unsatisfactory result months or years later and complications are not as responsive to surgical correction as in the case of a supracondylar humeral fracture.

Milch has classified this injury into two types. In type 1 injury, the fracture line runs lateral to the capitulotrochlear groove and shears off a portion of the lateral condylar epiphysis maintaining the joint as stable (partial retention of lateral column). However this fracture has a greater potential for growth disturbances. In type 2 injury, the fracture line runs into the apex of the trochlea with total loss of lateral support thereby rendering the elbow unstable. The lateral condyle fracture almost always displaces due to the attachment of the extensor group of muscles on the lateral epicondylar area. In its full and final displacement, the fragment is rotated 180 degree coronally and 90 degree in the horizontal plane such that the fracture surface faces outwards.

The patient has little soft tissue swelling in contrast to a supracondylar fracture, and most of it is concentrated on the lateral epicondylar area of the humerus. It may be possible to clearly feel the fracture and move the fragment. A radiographic study is confirmatory.

Undisplaced fracture do not require anything other than an above elbow backslab with elbow in 900 flexion and forearm in pronation for 3 weeks. However one must be certain on clinical examination that the fragment does not have a potential to displace. Any crepitus or huge soft tissue swelling points to instability and makes operative treatment a better choice. Open reduction and internal fixation has become the most widely accepted choice of treatment. Internal fixation is most commonly carried out using smooth K - wires in various configurations after obtaining anatomical reduction. It is imperative to preserve soft tissue attachments while carrying out the procedure. It is believed that when children present with fractures that are older then 3 weeks, it is best to leave them alone as they fare poorly if operated. However, we do not subscribe to this view.

A suboptimal reduction can result in a cosmetic deformity as well as functional loss. Other complications are delayed union, nonunion, epiphyseal growth arrest, lateral condyle overgrowth, valgus and varus deformity of elbow, immediate and tardy nerve palsy, myositis ossificans, trochlear fishtailing and epiphyseal avascular necrosis.

Generally, a fresh fracture which is well reduced, adequately fixed and managed well postoperatively give excellent results in form of restored anatomical contours, resumption of normal growth and regaining of a full range of motion.

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