Lateral condyle humerus fractures in children have a special place in all trauma literature. Delayed presentations are seen sometimes and pose a difficult Decision Making Scenario. We a providing a review which might help in decision making in delayed presentation of Lateral condyle humerus fractures


Delayed presentation may be defined as untreated fractured of more than 4 weeks duration (some define it as 3 weeks). Since Nonunion of lateral condyle is defined if no attempt to union is seen at 8 to 12 weeks post trauma, this duration between 4 weeks to 12 weeks post injury can be taken as delayed presentation of lateral condyle fracture and we will deal with the same in this review.

Earlier studies

Early studies advices against doing ORIF if the fracture is older than 4 weeks [1-4]. The main issue was stripping of vascularity leading to AVN and the prevalent thought was that any issue arising from nounion or malunion were much easier to handle than surgical management of delayed cases.

Changing Paradigm

Few earlier studies reported good outcome with surgical management of delayed cases [5-7]. Recently few articles have tried to resolve issue of decision making and showed good results. Article by Sharaf and  Khare found that Open reduction and internal fixation is recommended in all cases of displaced fractures of the lateral condyle of the humerus presenting at up to 12 weeks post injury. However, the results become poorer with increase in duration after injury and the grade of displacement. To avoid complications it is important to carry out careful dissection of the soft tissue attachments and to mobilize the fragment without the use of force [8].

Recent AAOS article [9] commented that a minimal to medrate displacement can be operated but a severaly displaced delayed lateral condyle may require extensive soft tissue dissection and might not be advisable.  Alternatively, there may be a role for delayed  fixation of significantly displaced nonunion, especially in cases of pain, substantial instability, or poor range of motion [10]. Watenbarger et al [10] commented that in fractures with >1 cm of displacement, fragment position was minimally improved surgically, but final alignment and range of motion were good. These fractures showed more radiographic deformities at the time of late open reduction. The risk of AVN with late open reduction of LCF at >3 weeks is reduced if no tissue is stripped off the fracture fragment posteriorly. Even children without anatomic reduction had functional arms with little or no pain.

Most Recent study by agarawal et al states that there is high rate of union and satisfactory elbow function in late presenting lateral condyle fractures in children following osteosynthesis attempt [11].


Traditional teaching suggest that open reduction should not be performed in fractures seen > 3weeks after injury as risk of poor results from stiffness and AVN increase. However if one carefully avoids posterior dissection to preserve blood suppy to distal fragment, good results can be achieved even at 8 to 12 weeks post injury. 

A key approach to avoiding trouble in late lateral condyle fractures is not necessarily aim for perfect anatomical reduction. It is preferable to fix it where it lies with no posterior stripping. Gaur et al commented that the common extensor origin in contracted in some cases and careful lengthening of this may help in achieving reduction without compromising vascularity [12]. In these cases consider rigid fixation using compression screws to maximise healing and promote early mobilisation


1.  Dhillon KS, Sengupta S, Singh BJ. Delayed management of fracture of the lateral humeral condyle in children. Acta Orthop Scand. 1988;59:419–24

2. Jakob R, Fowles JV, Rang M, Kassab MT. Observations concerning fractures of the lateral humeral condyle in children. J Bone Joint Surg Br. 1975;57:430–6.

3. Fontanetta P, Mackenzie DA, Rosman M. Missed, maluniting, and malunited fractures of the lateral humeral condyle in children. J Trauma. 1978;18:329–35.

4.Aggarwal ND, Dhaliwal RS, Aggarwal R. Management of the fractures of the lateral humeral condyle with special emphasis on neglected cases. Ind J Orthop. 1985;19:26–32.

5.  Shimada K, Masada K, Tada K, Yamamoto T. Osteosynthesis for the treatment of non-union of the lateral humeral condyle in children. J Bone Joint Surg Am. 1997;79:234–40. 

6. Mazurek T, Skorupski M. Nonunion of the lateral humeral condyle-operative treatment, case report.Chir Narzadow Ruchu Ortop Pol. 2006;71:227–9. 
7. Roye DP, Jr, Bini SA, Infosino A. Late surgical treatment of lateral condylar fractures in children. J Pediatr Orthop. 1991;11:195–9.

8. Saraf SK, Khare GN. Late presentation of fractures of the lateral condyle of the humerus in children. Indian J Orthop. 2011 Jan;45(1):39-44

9.  Tejwani N, Phillips D, Goldstein RY. Management of lateral humeral condylar fracture in children. J Am Acad Orthop Surg. 2011 Jun;19(6):350-8.

10. Wattenbarger JM, Gerardi J, Johnston CE. Late open reduction internal fixation of lateral condyle fractures. J Pediatr Orthop. 2002 May-Jun;22(3):394-8.

11.  Agarwal A, Qureshi NA, Gupta N, Verma I, Pandey DK. Management of neglected lateral condyle fractures of humerus in children: A retrospective study. Indian J Orthop. 2012 Nov;46(6):698-704.

12.  Gaur SC, Varma AN, Swarup A. A new surgical technique for old ununited lateral condyle fractures of the humerus in children. J Trauma. 1993 Jan;34(1):68-9.