The most common complication of lateral condylar fracture in children is:
Correct Answer: Valgus deformity
Description: Ref: Apley's System of Orthopaedics and Fractures, 9th editionExplanation:LATERAL CONDYLAR FRACTURES IN CHILDRENMost commonly around 6 years of age.Most common distal humeral epiphyseal fracture.Milch classification: Two types of lateral condylar fractures.Milch Type IFracture extends medially from the metaphysis into the capitellotrochlear groove.It is a Salter-Harris type IV injury.It is less common than Milch type II fracture and is more stable than type II.Milch Type IIFracture line extends from the metaphysis into the physeal plate and exits in the groove of the trochlea.More unstable than type I, hence displaces more commonly.It is a Salter-Harris type II physeal injury.CLASSIFICATION OF PHYSEAL INJURIESAny injury in the ends of the long bone in the presence of an unfused growth plate is a physeal injury: behaves different from an adult fracture due to the growing potential of the physis.Injury to one part of the physis leads to grow th arrest on that side leading to progressive deformities, e.g.. Genu varum - from injury to medial physeal plate: cubitus valgus from injury to lateral physeal plate.Most commonly used classification for physeal injury - Salter-Harris classification.SALTER-HARRIS CLASSIFICATIONBased on the radiographic appearance of the fracture.Higher the classification, more likely is the physeal arrest and complications.Type 1 - Epiphyseal separations through the physis only + displacement.Type II - Fracture line starts from the metaphysis and enteral and extends along the physeal plate.Thurston-Holhind sign or Thurston-Holland fragment - The metaphyseal spike attached to the separated epiphysis is called Thurston-Holland fragment.Type III - Fract ire extends through part of the physeal plate and passes through the epiphysis into the joint.Type IV - Fracture starts at the metaphysis and passes through the physis and epiphysis and into the joint.Type V - Compression fracture of the physis.Cannot be visualized radiologicalIv as there is no fracture line visible in radiograph.Can only be diagnosed retrospectively after development of progressive shortening or deformity of the bone.Other methods of classification - Peterson, Kang. Ogden. Weber. Poland.Mnemonic for Salter-Harris classification - SALTER.Assume a long bone with the epiphyses at the base.Type I - S = Slip (separated) - Fracture of the cartilage of the physis (growth plate).Type II - A = Above - Fracture lies above physis or Away from joint.Type 111 - L = Lower - Fracture is below physis in the epiphysis.Type 1V - TE = Through Every thing - Fracture is through the metaphysis, physis and epiphysis.Type V - R = Rammed (crushed) - Physis is crushed.Mnemonic for order of formation of secondary ossification centres in the distal humerus: CRITOESecondary ossification centre (approx)Formation yearCapitellum1 yearRadial head3 yearsInternal (Medial) epicondyle5 yearsTrochlea7 yearsOlecranon9 yearsExternal (Lateral) epicondyle11 yearsNOTELateral condyle epiphysis forms the capitellum and the lateral flange of the trochlea.Medial condyle epiphysis forms the medial flange of the trochlea.Hence the trochlea develops from both medial epiphy sis and the medial half of the lateral epiphysis.
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Orthopaedics
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