• Second most common fracture of the elbow
• Varus force on extended, supinated elbow

Classification

Milch

Type	Description
1	lateral throught the trochlear groovesplits the ossification center of the capitellumSH IV
2	passes into the trochlear region between the ossification centerslike SH 2

Jacob

Stage	Description
1	articular surface is intact
2	into joint but no fracture fragment rotation
3	rotated & displaced

• Stage 1 & 2 can be treated closed

Treatment

• If the displacement is greater than 1 mm or more than 2 mm vertical then the articular portion is likely disrupted & unstable
• If undisplaced (< 2mm)
  • treat with cast & frequent re-xray
  • if displaces later then 2 weeks there is a high incidence of  AVN with ORIF
  • care must be taken to avoid dissecting posteriorly
• If displaced greater than 3 mm
  • open reduction bringing the extensor wad forward
  • do not stripping posteriorly to avoid AVN of the capitellum
  • use two pins one through the capitellum & the other in metaphysis

Complications

Late Nonunion

• May see proximal migration, cubitus varus  & tardy ulnar nerve palsy
• Preoperative get NCS & EMG
• Fix the fragment in situ with minimal stripping
• Transpose ulnar nerve
• Subsequent supracondylar osteotomy

Lateral Epicondyle Fracture

• Typically treated conservatively