• OBJECTIVE
    • To compare intra-operative findings of fractures of the lateral condyle of the humerus in children with existing pre-operative radiographic classification.
  • DESIGN
    • Prospective, consecutive.
  • SETTING
    • Large urban hospital.
  • PATIENTS
    • 25 consecutive displaced lateral condyle (humerus fractures) in 25 children diagnosed on biplanar radiographs.
  • INTERVENTION
    • Open reduction and internal fixation through a lateral approach to the elbow.
  • MAIN OUTCOME MEASUREMENTS
    • Anatomic variations of the lateral condyle of the distal humerus based upon intra-operative observations; comparison of findings with pre-operative radiographic classification.
  • RESULTS
    • Three anatomic types were identified: 1) nine fractures exited on the medial side of the capitellum in the capitello-trochlear groove (36%), 2) eleven fractures exited beyond the capitello-trochlear groove through the trochlear epiphysis (44%), and 3) five fractures extended across the physis medially (20%). No fracture appeared to transverse the ossified portion of the capitellum (Milch Type I). The Milch anatomic classification was found to be inaccurate in 52% of the fractures.
  • CONCLUSION
    • Intraoperative findings did not correlate with the presumed preoperative radiographic diagnosis in the majority of cases. A heightened awareness of the limitations of this traditional classification system is required for operative decision.