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Medial Condyle Fracture (Peds)
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Contents
Other Names
- Medial Epicondylar Fracture
Background
- Fracture of the medial condyle of the Humerus seen in children
- Equivalent to a Salter Harris Fracture type IV
Epidemiology
- Most commonly seen in children age 10-14
- Rare, represents 1-2% of distal humeral fractures[1]
Pathophysiology
- Multiple potential mechanisms [2]
- Chronic avulsion injury due to valgus stress and contraction of Common Flexor Tendon, Ulnar Collateral Ligament
- Axial compression with valgus stress (FOOSH)
- Direct impact of olecranon to medial condyle
Ossification Centers of the Elbow
| Ossification center | Age of Appearance on Xray | Age of fusion |
| Capitellum | 1 | 12 |
| Radial Head | 3 | 15 |
| Medial Epicondyle | 5 | 17 |
| Trochlea | 7 | 12 |
| Olecranon | 9 | 15 |
| Lateral Epicondyle | 11 | 12 |
Associated Injuries
- Elbow Dislocation
- Ulnar Nerve Injury
- Rare, only 1 case reported in literature[3]
Risk Factors
- Unknown
Differential Diagnosis
- Fractures
- Adult
- Pediatric
- Dislocations & Instability
- Tendinopathies
- Bursopathies
- Ligament Injuries
- Neuropathies
- Arthropathies
- Other
- Pediatric Considerations
- Little League Elbow
- Panners Disease (Avascular Necrosis of the Capitellum)
- Nursemaids Elbow (Radial Head Subluxation)
Clinical Features
- General: Physical Exam Forearm
- History
- Medial elbow pain
- May endorse acute trauma
- May also have chronic overuse history
- Physical
- May observe swelling, bruising
- Valgus instability
Evaluation
- Radiographs
- Standard 3 view elbow
- Internal oblique view best evaluates displacement
- Distal humeral axial view helpful to evaluate displacement
- Diagnosis more challenging in younger children due to open capitellum physis until around age 12
- CT
- More accurate, tend to avoid when possible due to radiation
Classification
- N/A
Management
Nonoperative
- Indications are controversial[4]
- <5 mm displacement, however this can be challenging to assess radiographically
- Immobilization
- Long Arm Cast flex to 90°
Operative
- Indications
- Significant displacement
- Entrapment of fragment within joint
- Extension of fracture into articular surface
- Open
- Ulnar nerve dysfunction
- Associated elbow dislocation
- Technique
- Open reduction, internal fixation
Return to Play
- Variable, at discretion of surgeon
Complications
- Non-union[5]
- Ulnar Nerve Injury
- Stiffness/ Loss of ROM
- Physeal Arrest
See Also
- Internal
- External
- Sports Med Review Elbow Pain: https://www.sportsmedreview.com/by-joint/elbow/
References
- ↑ Bensahel H, Csukonyi Z, Badelon O, Badaoui S (1986) Fractures of the medial condyle of the humerus in children. J Pediatr Orthop 6(4):430–433
- ↑ Chacha PB (1970) Fracture of the medical condyle of the humerus with rotational displacement. Report of two cases. J Bone Joint Surg Am 52(7):1453–1458
- ↑ Chacha PB. Fracture of the medial condyle of the humerus with rotational displacement: report of two cases. J Bone Joint Surg Am 1970; 52: 1453–8
- ↑ https://www.orthobullets.com/pediatrics/4008/medial-epicondylar-fractures--pediatric
- ↑ Ryu K, Nagaoka M, Ryu J (2007) Osteosynthesis for nonunion of the medial humeral condyle in an adolescent: a case report. J Shoulder Elbow Surg 16(3):e8–e12
Created by:
John Kiel on 18 June 2019 01:16:40
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Last edited:
13 October 2022 13:26:10
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