When is reduction (non-operative or operative) required? Note also that the opposing joint surfaces of the olecranon and trochlea are not congruent.ħ. On the lateral view, the fragment appears as an additional bony opacity interposed between trochlea and olecranon. On the AP view, the medial epicondyle is missing (red arrow).
It is important to check that the medial epicondyle is present in its anatomical position. This can be difficult to identify on x-ray. If there is any doubt that the medial epicondyle is trapped in the joint, an urgent open reduction and internal fixation is needed.įigure 4: With an elbow dislocation, the medial epicondyle can be incarcerated in the joint (white arrow) following reduction. Always do repeat x-rays to check that the medial epicondyle is not incarcerated in the joint. Fifty percent of medial epicondyle fractures are associated with an elbow dislocation, which is easily identified on x-ray.Īn elbow dislocation requires urgent closed reduction. Medial epicondyle fracture with elbow dislocationįigure 3: Nine year old with elbow dislocation and fracture of the medial epicondyle (white arrow). B) Due to the child's age and type of sporting activity, management was open reduction and internal fixation. It is more difficult to see on the lateral view due to the splint. The medial epicondyle is separated >5 mm (red arrow). Undisplaced or minimally displaced fractures (5 mm)įigure 2: A) Thirteen year old gymnast with medial epicondyle fracture. All medial condyle fractures require a review with the nearest orthopaedic on call service Medial condyle fractures are intra-articular (extends into the joint) fractures. What do they look like on x-ray?Īlthough rare, it is important to distinguish a medial epicondyle fracture from a medial condyle fracture. It is very important to identify any injuries in the forearm as this has major implications with regards to swelling. If there is clinical suspicion of injury in the forearm or wrist then separate films of these areas should be ordered. What radiological investigations should be ordered?Īnteroposterior (AP) and lateral x-rays of the elbow should be ordered. What do they look like - clinically?Ī child presenting with a medial epicondyle or condyle fracture of humerus presents with tenderness and swelling at the medial aspect of the elbow. They are usually a result from an avulsion (pull off) injury caused by a valgus stress at the elbow and contraction of the flexor muscles.įifty percent of medial epicondyle fractures are associated with an elbow dislocation. They occur between the ages of 7-15 years. Medial epicondyle fractures are common and account for 10% of all elbow fractures in children. How common are they and how do they occur? These fractures can be classified based amount of displacement and whether the medial epicondyle is incarcerated within the joint. The injury is usually extra-articular but can be sometimes associated with an elbow dislocation. A medial epicondyle fracture is an avulsion injury of the attachment of the common flexors of the forearm. The medial epicondyle is a secondary growth centre at the elbow, which first appears around age 6 and fuses to the shaft of the humerus at about age 14-17 years. If there is any doubt, urgent ORIF should be performed If closed reduction for an elbow dislocation is performed, always order repeat x-rays to check that the medial epicondyle fracture is not trapped in the joint.
Refer to the nearest orthopaedic on call service. Medial condyle fractures are intraarticular, extending into the elbow joint and require urgent open reduction internal fixation (ORIF).ġ5 mm displacement (with elbow dislocation) It is important to distinguish a medial epicondyle fracture (common) from a medial condyle fracture (very rare). What are the potential complications associated with this injury?įifty percent of medial epicondyle fractures are associated with an elbow dislocation.What is the usual ED management for this fracture?.
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