Introduction: There is very limited literature describing the association of lateral condyle mass (LCM) fracture of the distal humerus associated concurrently with olecranon fracture. Herein, a case is reported of a displaced LCM fracture with displaced olecranon fracture, due to complex trauma while getting out of a vehicle, which was managed by open reduction and internal fixation.



Case Presentation: A 4.5- year- old boy suffered severe pain and swelling around his right elbow due to trauma which he suffered while trying to get out of a vehicle which was in motion. Plain radiographs of the anteroposterior, lateral, and oblique views showed a displaced lateral mass fracture associated with a displaced olecranon fracture. Open reduction and internal fixation was carried out and near normal function was achieved.



Conclusions: In view of the paucity of literature and rare incidence of this injury, this case report highlights the need to be aware of other injuries which can occur in association with LCM fractures in children

Ahmad Khan, H.

Ashraf Khan, M.

Bashir Shah, A.

Bhat, S.

Farooq, M.

Gani, N.

Kamal, Y.

Archives of Trauma Research

kashan university of medical sciences

Arch Trauma Res. 2016 September; 5(3):e24760.
Published online 2016 May 11.
doi: 10.5812/atr.24760.
Case Report
Concurrent Lateral Condyle Mass Fracture With Olecranon Fracture: A
Case Report and Brief Review of Literature
Munir Farooq,1 Younis Kamal,1,* Hayat Ahmad Khan,1 Naseemul Gani,1 Adil Bashir Shah,1 Mohammed
Ashraf Khan,1 and Shahid Bhat1
1Postgraduate Department of Orthopaedics, Government Medical College, Jammu and Kashmir, India
*Corresponding author: Younis Kamal, Postgraduate Department of Orthopaedics, Government Medical College, Srinagar, Jammu and Kashmir, India. Tel: +91-06966960, Fax
+91-1942423389, E-mail: kdryounis@gmail.com
Received 2014 October 27; Revised 2015 February 09; Accepted 2015 November 30.
Abstract
Introduction: There is very limited literature describing the association of lateral condyle mass (LCM) fracture of the distal humerus associated concurrently with
olecranon fracture. Herein, a case is reported of a displaced LCM fracture with displaced olecranon fracture, due to complex trauma while getting out of a vehicle, which
was managed by open reduction and internal fixation.
Case Presentation: A 4.5- year- old boy suffered severe pain and swelling around his right elbow due to trauma which he suffered while trying to get out of a vehicle
which was in motion. Plain radiographs of the anteroposterior, lateral, and oblique views showed a displaced lateral mass fracture associated with a displaced olecranon
fracture. Open reduction and internal fixation was carried out and near normal function was achieved.
Conclusions: In view of the paucity of literature and rare incidence of this injury, this case report highlights the need to be aware of other injuries which can occur in
association with LCM fractures in children.
Keywords: Lateral Mass Fracture, Olecranon Fracture, Complex Elbow Injuries
1. Introduction
Fractures involving the lateral condylar region in the
immature skeleton either cross the physis or follow it for
a short distance into the trochlea. They constitute about
16.9% of all distal humeral fractures (1). Fractures of the lat-
eral condyle physis are only occasionally associated with
other injuries like dislocation of the elbow, radial head
fracture, and fractures of the olecranon. There is very lit-
tle literature describing an association of LCM fracture of
the distal humerus associated concurrently with olecra-
non fracture (2). Undisplaced LCM fractures of the elbow
in children can be managed conservatively while displaced
fractures require open reduction and internal fixation (3-
6).
This article presents a case report of a displaced LCM
fracture with displaced olecranon fracture due to complex
trauma while getting out of a moving vehicle, which has
been managed by open reduction and internal fixation.
2. Case Presentation
A 4.5- year- old boy suffered severe pain and swelling
around his right elbow joint due to trauma he received
while he tried to get out of a vehicle in which he was trav-
elling, while the vehicle was still running. Initially, when
he opened the rear door of the vehicle, the driver applied
the brakes, and suddenly, he suffered direct trauma to his
right elbow due to deceleration of the vehicle. He fell on
the road on his outstretched hand and suffered direct, as
well as indirect (double), trauma in the same event. On pre-
sentation to the emergency department, the movements
of his elbow joint were painful and limited. A neurovascu-
lar examination of his right upper extremity was normal.
There was no past history of right elbow joint injury and
his past medical history was unremarkable.
Plain radiographs of the elbow joint (anteroposterior,
lateral, and oblique views) showed a displaced LCM frac-
ture associated with a displaced olecranon fracture (Fig-
ures 1 and 2). After preliminary splintage of the limb, the
patient was planned for open reduction and internal fixa-
tion.
Under general anaesthesia and via the posterior para-
triceptal approach to the elbow joint, the lateral condyle
fracture was anatomically reduced under direct vision and
fixed with two K-wires laterally. After stabilizing the LCM
fracture, the olecranon fracture was reduced by towel clip
and fixed with two K-wires. The two fixed fractures were
found stable on full range of motion of the elbow joint. The
wound was closed back in layers, the wires were embedded
under the skin and posterior above, and an elbow splint
was applied. The patient was discharged on the splint and
followed in the outpatient clinic weekly with check X-rays
at 1, 3, and 6 weeks (Figures 3 and 4). The posterior splint
Copyright © 2016, Kashan University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial
4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the
original work is properly cited.
Farooq M et al.
Figure 1. Preoperatvie X Ray AP View
Figure 2. Preoperative X Ray Lateral View
was removed at 6 weeks and the K-wires were removed at 8
weeks on day care basis under intravenous sedation. Range
of motion exercises of the elbow joint were started and
the patient was followed in the outpatient clinic monthly
up to 6 months with follow-up X-rays at 3 months and 6
months. At the 6 month interval, the patient had no pain
or instability around the right elbow joint and had nearly
full range of motion; flexion 1300, extension 0°, pronation
70°, supination 80°. The X-rays at 6 months showed bony
union of both the lateral condyle and olecranon with no
signs of capitular necrosis (Figure 5). The carrying angle of
the right upper limb was comparable to the opposite side.
At 12 weeks follow-up, the clinical photos are shown in Fig-
ure 6.
Figure 3. Immediate Postoperative X Ray
Figure 4. Immediate Postoperative X Ray Lateral View
3. Discussion
In view of the paucity of literature and rare incidence
of such injuries, this case presentation highlights the pres-
ence of other injuries which can occur in association with
LCM fractures in children. The importance of understand-
ing the mode of complex trauma and the fracture pattern
around the elbow joint is highlighted in the case report.
2 Arch Trauma Res. 2016; 5(3):e24760.
Farooq M et al.
Figure 5. X Rays at 6 Months
LCM fractures usually occur between the ages of 5 to 10
years. The suggested mechanism of injury for LCMs are
push-off and pull-off mechanisms (7). Herein, the authors
think push-off of the lateral condyle by the radial head due
to falling on an outstretched hand is a possible mechanism
of injury in this patient as the forearm goes into valgus
when extended. Fracture of the olecranon is due to the di-
rect trauma to the elbow by the vehicle door due to deceler-
ation of the vehicle. The two impacts of traumatic forces in
one event is one thing which distinguishes this case from
other reports mentioned in the literature. Even though
this is a less common mechanism of olecranon injury, the
authors maintain that this is the cause of the olecranon
fracture in this patient (8). Displaced fractures of the lat-
eral condyle need anatomical reduction and fixation since
this is a Salter Harris type IV injury and inadequately re-
duced and treated fractures lead to nonunion, malunion,
carrying angle abnormalities, and late onset neural palsy
(1, 7, 9, 10). Metaphyseal olecranon fractures are due to a
direct blow to the elbow. Graves and Canale (11) recom-
mended that surgical intervention is to be limited to those
patients with > 5 mm of displacement of the fracture ends.
The olecranon fracture in this case was displaced and so
was managed by open reduction and internal fixation.
Wilkins (12) recommended assessing the stability of
the olecranon fracture by direct palpation and flexion of
the elbow joint. If either manoeuvre causes separation of
the fragments, open reduction and internal fixation is re-
quired. Most of these cases of olecranon fractures have
been diagnosed intraoperatively in other reported series.
However, in this, report, the fracture was diagnosed preop-
eratively due to the displaced olecranon fracture.
Pace et al. published a case report of combined olecra-
non and LCM fractures in 2005 (2). Previous reports of con-
comitant LCM-olecranon fractures have been documented
without further details by Gicquel et al. (13) (1 of 26), by
Caterini et al. (14) (4 of 63), and by Gaddy et al. (15) (1 of
35).
Sharma et al. have found a significant difference in
the ages of children with LCM injury and suggested that
the olecranon is weaker in the younger child and fails next
after the LCM. In older children, the ligaments, particu-
larly the medial collateral, are probably the next weak-
est link after the LCM. They also suggested that an undis-
placed LCM cohort with associated olecranon fracture can
be treated nonoperatively, without assessment of stability,
under general anesthesia. The present case was managed
by internal fixation due to displaced fractures of the ole-
cranon and lateral condyle. Displaced LCM-olecranon frac-
tures should be managed by open reduction and internal
fixation, as suggested by Sharma et al. (16).
This case illustrates that proper understanding of the
normal anatomy of pediatric elbows and possible mech-
anisms of injury are of the utmost importance in under-
standing the different types of elbow injuries and their
possible association with other injuries. This is the hall-
mark for early decision, management, and rehabilitation
of such injuries in children.
Footnote
Authors’ Contribution: Munir Farooq described the
mechanism of injury and review of literature. Younis Ka-
mal drafted the manuscript and compiled of the data, clin-
ical photos, and x-rays. Hayat Ahmad Khan helped in the
initial writing of the manuscript and literature review of
the manuscript. Naseemul Gani helped in writing up of
the discussion part of the manuscript. Adil Bashir Shah
collected the references for the article. Mohammad Ashraf
Khan helped in collecting the patient profile. Shahid Bhat
helped writing the references of the manuscript.
Arch Trauma Res. 2016; 5(3):e24760. 3
Farooq M et al.
Figure 6. Showing Clinical ROM at 12 Weeks
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4 Arch Trauma Res. 2016; 5(3):e24760.


Concurrent Lateral Condyle Mass Fracture With Olecranon Fracture: A Case Report and Brief Review of Literature

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Concurrent Lateral Condyle Mass Fracture With Olecranon Fracture: A Case Report and Brief Review of Literature

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