13 y-o girl. Fell from bicycle the day before. Referred from a nearby hospital. Otherwise healthy. Swollen around the elbow which she keeps in semiflexed position adducted to the trunk. No neurovascular compromise.
Factors to consider:
- Fracture type?
- Pathomechanism?
- Injured soft tissue components?
- Treatment alternatives?
- Surgical approach?
- Mode of fixation?
- Aftercare?
- Prognosis?
Adult fracture in a child. Does this matter?
Almost mature skeleton which likely is the reason for this kind of fracture. A similar trauma in a younger child would probably have caused a different injury. The fact that it looked like a fracture in an adult also made adult principles of fixation amenable.
Approach
Anterolateral and posterolateral areas of the Joint and humerus need to be approached.
With the patient in a supine position, a posterolateral incision was used. The incision was placed just behind the lateral condyle, extending over the Kocher interval down to the insertion of the collateral ligament complex on the ulna. The fascia over the Kocher interval was incised and followed proximally immediately posterior to the lateral column, releasing the triceps from humerus.
The fractured lateral condyle was mobilized together with the attached ligaments and extensor muscles. The intraarticular fragments were reduced and temporarily fixed with K-wires. Because the coronal shear fragments were thick, fixation from posterior was decided in order not to disturb the articular surfaces. A posterolateral plate with a lateral flange was therefore used.
Approach without jeopardizing the radial nerve and allowing both posterior and anterior access.


