This fracture is mostly seen in children around puberty.
The morphology of the fracture is similar to the adult Y-fracture (13-C). The main difference from adult fractures is the mostly uncomplicated and rapid healing, and less tendency for joint stiffness in children. In the child approaching skeletal maturity the presence of growth plates can be ignored if the fixation technique demands.
The goal of the treatment is to restore the articular surface, then to fix the reassembled condylar mass to the shaft of the humerus, as for a type IV supracondylar fracture.
For an anatomical restoration of the joint surface, open reduction and rigid fixation is necessary.
The reattachment of the condylar mass to the shaft of the humerus can be achieved in a variety of a ways depending on the age of the child and fracture morphology. For example, a 6-year old child with a low fracture may heal rapidly with K-wire fixation alone, whereas an adolescent with a high fracture would be more suitable for dual plate fixation.
The following two approaches are recommended:
- Posterior approach (as in adults), with or without olecranon osteotomy
- Lateral open approach to visualize the joint surface, followed by reduction of the fragments, fixation of the articular fragments with a lag screw, and then fixation of the condylar mass to the shaft fragment by two or three 2.0 mm threaded K-wires
Timing of treatment
These fractures do not require emergency surgery unless they are open or associated with neurovascular complications.
There is evidence that in nonurgent cases a delay in treatment of up to 2-3 days has no negative effect on healing or outcome.
The following points influence the timing of the treatment:
- Availability of surgical resources, including an experienced surgeon
- The patient should be treated on a routine operating list, preferably the day after injury. In the meantime, plaster splint immobilization and elevation of the elbow joint is recommended for pain management