Diagnosis and Treatment of Concomitant Lateral Condyle and Medial Epicondyle Fractures With Elbow Dislocation in Children

PURPOSE: A concomitant lateral condylar (LC) and medial epicondyle (MEC) fracture with elbow dislocation, also known as a bicondylar fracture-dislocation of the elbow (BiCFDE), is a rare phenomenon for which there is limited scientific literature. This study evaluated the clinical and radiologic outcomes of BiCFDE in pediatric patients. METHODS: A total of 6 males and 6 females were diagnosed with BiCFDE (left: 5, 41.7%; right: 7, 58.3%). The LC and MEC fractures were classified according to the Papavasiliou (4 type II and 8 type IV) and Milch (7 type I and 5 type II) classifications, respectively. All patients underwent surgery. Clinical and functional outcomes were evaluated using the carrying angle (CA), range of motion (ROM), and Kim and colleagues elbow performance score (EPS); related complications were recorded. The patients were divided into 2 groups. Group 1 included patients with LC Type I and MEC, and group 2 included patients with LC type II and MEC. RESULTS: The mean age at the time of injury was 9.1±3.2 years (range: 4 to 15 y), and the mean follow-up period was 50.5±20.4 months (range: 21 to 92 mo). All fractures consolidated in an average of 5.7±1.1 weeks (range: 4 to 8 wk). Outcomes ranged from good (n=1; 8.3%) to excellent (n=11; 91.7%). Comparing the injury mechanism of the subgroups, it was found that group 1 involved valgus stress on a hyperextended elbow. In contrast, group 2 involved varus stress. Group 1 patients were older (P<0.05); however, there were no significant differences in healing time, CA, or EPS scores between the 2 groups (P<0.05). CONCLUSIONS: Ipsilateral LC and MEC fractures, which are usually associated with elbow dislocation, are uncommon but present diagnostic and treatment challenges. The goal of surgery is to stabilize the elbow, and the procedure should be based on the mechanism of injury. With proper diagnosis and treatment, clinical and radiologic outcomes are usually favorable. LEVEL OF EVIDENCE: Level IV-case series.