Lateral condyle fractures are difficult to visualize radiographically and are prone to poor functional outcome when missed Most lateral condyle fractures are displaced intra-articular fractures (Salter–Harris type IV) and often require open reduction to anatomically reduce the articular surface Lateral condyle fractures are the second most common operative elbow fracture in children These fractures are easily missed radiographically due to the fracture fragment being primarily cartilage, especially in younger children The emergency clinician should have a high level of suspicion for this diagnosis in the setting of a FOOSH followed by isolated lateral elbow pain and tenderness, possibly accompanied by local swelling and ecchymosis Fracture pain is exacerbated with wrist flexion on examination Frequently, the lateral ligament and the common extensor tendon remain attached to the fracture fragment, which can be partially or totally avulsed from the distal humerus ( Fig 111.20 ) The lateral epicondyle ossifies at approximately 13 years old and fuses with the capitellum around age 16 years Consequently lateral condyle fractures are uncommon in the skeletally mature pediatric patient Routine anteroposterior and lateral plain radiographs usually provide adequate fracture definition for severely displaced fractures; however, with less severe injuries and before the capitellum is ossified, oblique views, stress views, CT scan, or an MRI study be needed Undertreated lateral condyle fractures have potential complications of displacement, malunion, and nonunion which may result in deformity and nerve palsy Orthopedic surgery consultation is recommended for surgical management of lateral condyle injuries with displacement of mm or greater Nondisplaced or minimally displaced (