A 14-year-old boy has a displaced lateral condyle fracture of the humerus with >2 mm displacement confirmed on CT. The Milch classification for this fracture determines the operative approach. A Milch Type II fracture is unstable because the fracture line passes through:

• A The capitello-trochlear groove, separating the lateral trochlear ridge with the fragment — disrupting the lateral elbow buttress ✓
• B The capitello-trochlear groove, leaving the lateral trochlear ridge intact with the humerus — keeping the elbow stable
• C The lateral epicondyle only, without involving the articular surface
• D The medial epicondyle apophysis, rendering the common flexor origin detached

Explanation

Milch classified lateral condyle fractures by the position of the fracture line relative to the trochlea. In Milch Type I, the fracture line passes lateral to the capitello-trochlear groove and does not traverse the trochlear articular surface, leaving the lateral trochlear ridge attached to the humerus — the elbow remains mechanically stable. In Milch Type II, the fracture line passes through the capitello-trochlear groove, taking the lateral trochlear ridge with the fragment, thereby destabilising the ulnohumeral joint. Type II fractures are therefore inherently unstable and require open reduction and internal fixation.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.