Medial epicondyle fracture (peds)

Background

• Not true Salter-Harris fracture (apophysis, not physis, is involved)
• 50% associated with elbow dislocation

Humerus Fracture Types

Humeral anatomy

• Adult
  • Proximal
  • Shaft
  • Distal
    • Capitellum
    • Trochlea
    • Condylar
• Pediatric
  • Proximal
  • Shaft
  • Distal
    • Supracondylar
    • Lateral epicondyle
    • Medial epicondyle

Clinical Features

• Mechanisms:
  • Posterior elbow dislocation
  • Repetitive stress ("Little League elbow")
• Exam: pain with pronation or elbow/wrist flexion
• May have associated ulnar nerve injury

Differential Diagnosis

Elbow Diagnoses

Radiograph-Positive

• Distal humerus fracture
• Radial head fracture
  • Essex-Lopresti fracture
• Capitellum fracture
• Olecranon fracture
• Elbow dislocation

Radiograph-Negative

• Biceps tendon rupture/dislocation
• Lateral epicondylitis
• Medial epicondylitis
• Olecranon bursitis (nonseptic)
• Pronator teres syndrome
• Septic bursitis

Pediatric

• Nursemaid's elbow
• Supracondylar fracture
• Lateral epicondyle fracture
• Medial epicondyle fracture
• Olecranon fracture
• Radial head fracture
• Salter-Harris fractures

Evaluation

Pediatric medial epicondyle fracture.

• Displacement of medial epicondyle ossification center
• May become entrapped within elbow joint
• Use CRITOE to determine if bone in joint is medial epicondyle or normal trochlear osseus center
  • If think is trochlear but cannot see medial epicondyle fragment is medial epicondyle
    • (Medial epicondyle normally ossifies before the trochlea)
• Fat pad sign not usually present because most injuries are extra-articular

Management

• Ortho consult
  • Long arm cast with elbow flexed 90˚ vs operative management

See Also

• Elbow diagnoses