Milch classification distal humerus articular fractures

Classification of condylar fractures according to Milch with the location of the common fracture lines seen in types I and II fractures of the lateral (B) and medial (C) condyles.

(A) Anterior view of the anatomy of the distal articular surface of the humerus. The capitello-trochlear sulcus divides the capitellar and trochlear articular surfaces. The lateral trochlear ridge is the key to analyzing humeral condyle fractures. In type I fractures, the lateral trochlear ridge remains with the intact condyle, providing medial-to-lateral elbow stability. In type II fractures, the lateral trochlear ridge is a part of the fractured condyle, which may allow the radius and ulna to translocate in a medial-to-lateral direction with respect to the long axis of the humerus.

(B) Fractures of the lateral condyle. In type I fractures, the lateral trochlear ridge remains intact, thereby preventing dislocation of the radius and ulna. In type II fractures, the lateral trochlear ridge is a part of the fractured lateral condyle. With capsuloligamentous disruption medially, the radius and ulna may dislocate.

(C) Fractures of the medial condyle. In type I fractures, the lateral trochlear ridge remains intact, thereby providing medial-to-lateral stability of the radius and ulna. In type II fractures, the lateral trochlear ridge is a part of the fractures medial condyle. With lateral capsuloligamentous disruption, the radius and ulna may dislocate medially on the humerus.