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The radiograph demonstrates a laterally displaced and rotated intra-articular lateral condylar fracture, a Type III fracture. Type I fractures are non-displaced, stable fractures that may be treated with a long arm cast, but must be followed closely for possible displacement. Type II fractures are minimally displaced and may undergo attempted closed reduction with percutaneous pinning if the fracture is able to be anatomically reduced and found to be stable with stress arthrography. If anatomic reduction is not obtained, open reduction with internal fixation must be performed. Type III fractures are displaced, unstable fractures that require open reduction and fixation. Although there have been recent articles published recommending attempted closed reduction on all fractures, Rockwood & Wilkin's still recommends against closed reduction for Type III fractures because of the difficulty maintaining reduction of these fractures.
Launay et al found that immobilization alone resulted in additional displacement and more nonunions than did operative treatment and concluded that displaced fractures should be fixed surgically.
The Sullivan article is an overview of lateral condyle fractures.
Illustration A displays the classification system of I, II, & III from left to right.