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Medial Condyle Fracture (Peds)

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Other Names

  • Medial Epicondylar Fracture

Background

Epidemiology

  • Most commonly seen in children age 10-14
  • Rare, represents 1-2% of distal humeral fractures[1]

Pathophysiology

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


Risk Factors

  • Unknown

Differential Diagnosis


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

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


See Also


References


  1. 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
  2. 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
  3. 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
  4. https://www.orthobullets.com/pediatrics/4008/medial-epicondylar-fractures--pediatric
  5. 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
Authors:
Last edited:
11 November 2020 14:37:58
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