Clinical analysis of lateral humeral condyle fracture complicated by elbow dislocation

doi:10.3877/cma.j.issn.1674-134X.2026.03.002

Abstract

Abstract:

Objective

Exploring the clinical characteristics of humeral lateral condyle fracture combined with elbow dislocation in children and the guiding value of classification based on the relative width of fracture fragments for diagnosis and treatment.

Methods

A retrospective analysis was performed on the clinical data of 19 patients with lateral humeral condyle fractures (LHCF) complicated by elbow dislocation admitted to the Department of Orthopedics, Children’s Hospital of Soochow University, from August 2021 to October 2024. Inclusion criteria: age <16 years, imaging-confirmed diagnosis, and complete follow-up records. Exclusion criteria: open fractures, severe multiple trauma, pathological fractures, and a history of prior elbow deformity or surgery. Patients were divided into two groups based on the ratio of the fracture fragment’s transverse diameter to the width of the lateral humeral condyle. The structural instability (SI) group (n=14) consisted of cases with a mean relative width >50%, while the ligamentous instability (LI) group (n=5) consisted of cases with a mean relative width <20%. Independent samples t tests, Mann-Whitney U tests, and Fisher’s exact tests were utilized to compare the differences between the two groups in terms of baseline characteristics, dislocation mechanisms, imaging features, treatment priorities, and clinical outcomes.

Results

There were no statistically significant differences between the two groups in terms of gender, age, injury side, time from injury to hospitalization, neurovascular injury, and length of hospital stay (all P>0.05). Significant differences in imaging characteristics were observed between the two groups: fractures in the SI group involved the epiphyseal plate and articular surface, while fractures in the LI group were confined to the metaphysis or the lateral aspect of the epiphyseal plate, with the articular surface remaining intact. Treatment strategies also differed between the groups: all patients in the SI group underwent surgery to restore articular anatomy and bony stability, including four cases of closed reduction and 10 cases of open reduction, with four cases supplemented by elbow arthrography. In the LI group, three patients with small fracture fragments, minimal displacement, and stable joints received conservative treatment, while two patients with radial collateral ligament injuries underwent surgical ligament repair. No statistically significant difference in postoperative Mayo score and Hospital for Special Surgery (HSS) score was found between the two groups (all P>0.05), and both achieved 100.0% excellent and good rate. None of the patients experienced complications such as nonunion, delayed union, avascular necrosis of the distal humerus, or elbow deformity.

Conclusions

The SI/LI classification, based on the average relative width of fracture fragments, effectively distinguishes between two primary injury patterns: structural instability and ligamentous instability. This classification offers significant guiding value for radiologic assessment and the selection of targeted treatment strategies. All the patients included in this study achieved excellent clinical outcomes following the specific interventions tailored to their respective injury patterns.

Key words: Humeral fractures, Elbow, Joint dislocations, Joint instability, Clinical Protocols, Prognosis, Child

Cong Liu, Bingqing Mao, Yunfang Zhen, Jianfeng Fang, Jun Wen, Yicong Liu, Tao Qian, Yao Liu. Clinical analysis of lateral humeral condyle fracture complicated by elbow dislocation[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(03): 266-274.

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https://zhgjwkzz.cma-cmc.com.cn/EN/Y2026/V20/I03/266

Figures/Tables 7

Figure 1 Illustration of measurements for width of the lateral humeral condyle and fracture fragment. A is measurement on X-ray image of elbow at anteroposterior view; B is measurement on the CT image of elbow at coronal view Note: line a-width of the lateral humeral condyle; line b-width of the fracture fragment; line c-reference line

Figure 2 Radiographic findings of left lateral humeral condyle fracture of left elbow complicated with elbow dislocation (structural instability type). A is coronal CT image of left elbow, showing a bone fracture of the lateral humeral condyle with the fracture line extending inferomedially and involving the articular surface; B is three-dimensional reconstruction of CT image for left elbow, showing fracture involving the epiphyseal plate and articular surface, with evident articular surface incongruity

Figure 3 Radiographic findings of left lateral humeral condyle avulsion fracture complicated by elbow dislocation (ligamentous instability). A is coronal CT image of the left elbow, showing a small avulsed fragment of the lateral humeral condyle with the fracture line confined to the lateral aspect of the epiphyseal plate; B is three-dimensional reconstruction of CT image for the left elbow, showing that the fracture does not involve the articular surface , with the joint alignment remaining essentially intact

Table 1 Assessment of interobserver reliability for measurement data

影像学指标 Radiographic parameters	ICC	95%CI	P值
骨折块宽度（mm） Fracture fragment width	0.996	（0.990，0.998）	＜0.001
肱骨外髁宽度（mm） Lateral humeral condyle width	0.994	（0.986，0.998）	＜0.001
骨折块相对宽度（%） Relative width of fracture fragment	0.987	（0.969，0.995）	＜0.001

Table 2 Comparison of baseline characteristics between the two groups

项目 Subjects	SI组 SI group	LI组 LI group	统计值 Statistical values	P值	效应量 Effect size
例数 Number of cases	14	5
性别（男/女） Gender（male/female）	13/1	5/0	OR=0.78	＞0.05	φ=0.083
年龄［岁，（ $x ¯$ ±s）］ Age（year）	9.0±2.8	10.1±3.2	t=-0.72	＞0.05	d=-0.375
侧别（左/右） Side（left/right）	6/8	4/1	OR=3.33	＞0.05	φ=0.240
外伤到住院时间［h，M（P₂₅，P₇₅）］ Time from injury to admission	8.0（3.0，16.0）	5.0（2.0，20.0）	U=30.50	＞0.05	r=0.067
神经血管损伤（有/无） Neurovascular injury（yes/no）	1/13	1/4	OR=0.31	＞0.05	φ=0.143
住院天数［d，M（P₂₅，P₇₅）］ Length of hospital stay	5.0（4.0，6.0）	5.0（3.0，11.0）	U=34.00	＞0.05	r=0.011

Table 2 Comparison of baseline characteristics between the two groups

项目 Subjects	SI组 SI group	LI组 LI group	统计值 Statistical values	P值	效应量 Effect size
例数 Number of cases	14	5
性别（男/女） Gender（male/female）	13/1	5/0	OR=0.78	＞0.05	φ=0.083
年龄［岁，（ $x ¯$ ±s）］ Age（year）	9.0±2.8	10.1±3.2	t=-0.72	＞0.05	d=-0.375
侧别（左/右） Side（left/right）	6/8	4/1	OR=3.33	＞0.05	φ=0.240
外伤到住院时间［h，M（P₂₅，P₇₅）］ Time from injury to admission	8.0（3.0，16.0）	5.0（2.0，20.0）	U=30.50	＞0.05	r=0.067
神经血管损伤（有/无） Neurovascular injury（yes/no）	1/13	1/4	OR=0.31	＞0.05	φ=0.143
住院天数［d，M（P₂₅，P₇₅）］ Length of hospital stay	5.0（4.0，6.0）	5.0（3.0，11.0）	U=34.00	＞0.05	r=0.011

Table 3 Prognostic scores and excellent-to-good rates of the two groups

组别 Groups	例数 Number of cases	Mayo评分（ $x ¯$ ±s）	HSS评分（ $x ¯$ ±s）	优良率（%） Excellent-to-good rate
SI组 SI group	14	97.4±5.5	96.4±6.0	100.0
LI组 LI group	5	99.6±0.9	99.0±2.2	100.0
t值		-1.43	-1.36	-
P值		＞0.05	＞0.05	-
效应量（d值） Effect size		-0.45	-0.48	-

Table 3 Prognostic scores and excellent-to-good rates of the two groups

组别 Groups	例数 Number of cases	Mayo评分（ $x ¯$ ±s）	HSS评分（ $x ¯$ ±s）	优良率（%） Excellent-to-good rate
SI组 SI group	14	97.4±5.5	96.4±6.0	100.0
LI组 LI group	5	99.6±0.9	99.0±2.2	100.0
t值		-1.43	-1.36	-
P值		＞0.05	＞0.05	-
效应量（d值） Effect size		-0.45	-0.48	-

Figure 4 Images of left lateral humeral condyle avulsion fracture of the left elbow complicated with elbow dislocation. A is three-dimensional reconstruction of the elbow CT image, showing a small avulsed fracture fragment located at the lateral aspect of the distal humerus; B is cross-section CT image of the elbow, showing a free fracture fragment at the lateral aspect of the distal humerus; C is coronal CT image of the elbow, showing a small free bone fragment at the lateral aspect of the distal humerus; D is sagittal MRI image of the elbow, showing surrounding soft tissue injury and abnormal signal intensity in the lateral structural area; E is coronal MRI image of the elbow, showing avulsion fracture of the lateral humeral condyle with surrounding soft tissue injury, abnormal signal is visible at the attachment site of the lateral collateral ligament (LCL); F is axial MRI image of the elbow, showing lateral soft tissue injury and abnormal signal in the LCL region; G is coronal CT image of the elbow after surgery, showing the internal fixation screw in situ with good reduction of the fracture fragment; H is sagittal CT image of the elbow after surgery, showing favorable position of the internal fixation after fracture reduction; I is three-dimensional reconstruction of the elbow CT image after surgery, showing satisfactory reduction of the left lateral humeral condyle fracture with appropriate internal fixation positioning; J is radiograph of elbow at anteroposterior (AP) and lateral views one month after surgery, showing good reduction of the fixed fracture fragment and internal fixation in situ; K is radiograph of elbow at AP and lateral views three months after surgery, showing the screw in situ with good alignment and reduction of the fracture; L is radiograph of elbow at AP and lateral views five months after surgery, showing that the internal fixation was removed with good fracture healing and joint alignment

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