Displaced clavicle fractures in adolescents: facts, controversies, and current trends.

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Abstract

[Indexed for MEDLINE] 7. J Pediatr Orthop. 2025 Mar 1;45(3):e201-e206. doi: 10.1097/BPO.0000000000002863. Epub 2024 Dec 9. Pediatric Lateral Condyle Fractures With Elbow Dislocation: Revisiting the Song Classification of the Most Severe Injuries. Campbell L(1)(2), Baker CE(1), Rees AB(3), Johnson SR(2), Schultz JD(1), Wollenman LC(2)(4), Sborov KD(2), Hysong AA(3), Louer CR(1)(5), Lempert NL(1)(5), Moore-Lotridge SN(1)(6), Schoenecker JG(1)(5)(6)(7)(8). Author information: (1)Department of Orthopedics, Vanderbilt University Medical Center. (2)School of Medicine, Vanderbilt University. (3)Atrium Health Musculoskeletal Institute, Charlotte, NC. (4)Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN. (5)Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN. (6)Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN. (7)Department of Pharmacology, Vanderbilt University, Nashville, TN. (8)Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center. INTRODUCTION: Lateral condyle fractures are the second most common pediatric elbow fracture and are at risk for malunion, nonunion or avascular necrosis. The Song or Jakob classification guides management and risk of complications. However, many lateral condyle fractures have accompanying bony or soft tissue injuries, including elbow dislocations, which are not represented in the current Song or Jakob classification systems. Little is known about the incidence and outcomes of these more complex injuries. The purpose of this study was to describe the largest known case series of these injuries and characterize the incidence and outcomes. METHODS: Injury, presentation, treatment, and outcome data were retrospectively gathered on pediatric elbow fractures at a single center from November 2007 to October 2017. RESULTS: Of 4607 pediatric elbow fractures, 492 were lateral condyle fractures, with 30 cases (6.1%) presenting with concomitant elbow dislocation. Predominantly affecting males (76.7%) with a median age of 6.9 years, these injuries often resulted from intermediate energy mechanisms. High rates of coincident neurovascular deficits (23%), skin tenting (13.3%), and polytrauma (13.3%) were observed. All cases were treated surgically, primarily within 24 hours, with no instances of AVN, nonunion, or fixation failure reported. Across the cohort, there were 2 (6.7%) pin tract infections, 2 cases required return to the operating room, and 12 (40.0)% patients requiring outpatient physical therapy for elbow stiffness. CONCLUSIONS: Lateral condyle fractures with concomitant ulnohumeral dislocation are distinct and unstable injuries requiring prompt inpatient treatment. Current classification systems do not adequately address this fracture-dislocation combination, risking underdiagnosis and potentially delayed reduction of a dislocated elbow. We propose adding a "Song 6" or "Jakob 4" category to existing classifications to ensure these injuries are properly identified and managed. This amendment will improve clinical awareness, facilitate timely intervention, and optimize outcomes for pediatric patients with these complex fractures. LEVEL OF EVIDENCE: IV. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/BPO.0000000000002863