Fractures of the medial epicondyle of the distal humerus account for approximately 1220% of all pediatric elbow fractures and occur most frequently between the ages of 9 and 14 beaty, 2005. Medial epicondyle fractures demographic 20% of elbow fractures 60% of which are associated with elbow dislocation. Medial epicondyle fractures, transphyseal fractures, and elbow dislocations represent a spectrum of pediatric elbow injuries. The epicondyle can become injured in a number of different ways.
They are typically seen in children, and can be challenging to identify. Pdf operative versus nonoperative management of pediatric. Transphyseal fractures are thought to represent the corollary to the elbow dislocation in the very young patient. Louahem et al investigated the effectiveness of surgical treatment for elbow instability in 9 children with displaced medial epicondylar fractures of the elbow.
All fractures had associated with instability of the elbow. Pdf medial humeral epicondylar fracture in children and. Type 5 is a type 4 with fracture of medial condyle osteoporoticbone can be associated with undisplaced supercondylar fx. Medial epicondyle avulsion fractures elbow conditions. Anatomical, biomechanical and computer simulation models suggest great importance should be given to the medial epicondyle and the. The medial epicondylar fragment was anatomically reduced and fixed in all cases.
Management of condylar fractures linkedin slideshare. Reduce if displaced may be by open reduction, closed manipulation, or traction 3. Humeral medial epicondyle fracture management in the pediatric. This article discusses the management of humeral condylar fractures and iohc.
Supracondylar fractures of the humerus are the most frequent fractures affecting the paediatric elbow 1 and their correct management is important because they can cause catastrophic complications. They account for approximately 8% of all fractures in the elbow region,1 and 14% involve incarceration of the fragment. Medial humeral epicondylar fracture in children and. B due to the childs 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. They can usually be treated with splinting and early physiotherapy. This lesson explains what an epicondyle is, what a fracture is, and how a. Failure to diagnose these injuries can lead to significant long term disability.
The treatment of condylar fractures international journal. They represent 10% of all elbow fractures in children and usually occur in boys after a fall on an outstretched arm. Management of displaced extensiontype supracondylar fractures of the humerus in children. Despite there being a clear consensus about some issues regarding proper treatment of these fractures, controversy remains with regard to aspects such as the fact that there is no good. Optimal management of physeal elbow injuries in the. With the fracture reduced, a transcondylar hole is drilled beginning at a point just cranial and ventral to the palpable lateral epicondylar crest. It is a specialized part of some of the bones found in the human body. The general goals of fracture management are anatomic reduction of the fracture and protection of the soft tissue envelope. Elbow fractures in children orthopaedic trauma association. Pdf does computerized tomography change the treatment. The management of fractures of the medial humeral epicondyle is controversial, but the primary issue is the relationship of outcomes to the extent of fracture displacement. Surgical management of lateral humeral condylar fractures. Fractures were categorized as reconstructed when the fracture gap was epicondylar regions of the fracture and nonreconstructed when the fracture gap was.
They are much rarer than medial epicondyle fractures and represent avulsion of the lateral epicondyle. The disadvantage of these two methods of fixation is that the. Epidemiologically speaking, they account for nearly 12% of all elbow fractures 1 and are, therefore, not uncommon injuries. Summary we report a new intermaxillary fixation imf method for condylar fractures using a thermoforming plate. Occult supracondylar humerus fractures are common and suspected when there is a history of trauma, tenderness in the supracondylar region, and a radiographic elbow effusion posterior fat pad sign. The mean age of patients at the time of accident was 11. Fractures of the medial epicondyle are relatively rare injuries in children. Humeral condylar fractures and incomplete ossification of the humeral condyle. Unstable fractures typically require closed reduction or open reduction and. Some authors recommend anterior transposition of the ulnar nerve if the fracture involves the ulnar groove or if the nerve is injured. In young baseball players, the development of little leaguers elbow and insufficient rest may result in a medial epicondyle avulsion fracture.
Medial epicondyle fractures in the pediatric overhead. Management fracture management stages include 4 rs. With the intention of a speedy return to sport and normal function, he opted for open reduction and internal fixation orif. In some cases it may become fractured due to direct trauma. Three months after operation, he presented with limited range of motion rom of the right elbow caused by malunion of the lateral epicondylar fracture and subluxation of the radiohumeral joint. Treatment of paediatric medial epicondylar fractures of the elbow remains the domain of. Distal humerus fractures orthopaedic trauma association. A faint fracture line can sometimes be appreciated on the ap radiograph. Medial epicondyle fractures in adolescent athletes university of.
Once the fracture site is adequately exposed, fibrin, clots, blood, and interposed soft tissue should be removed to allow perfect anatomic reduction of the articular surface. Medial epicondyle fracture radiology reference article. Medial humeral epicondyle fractures represent approximately 12% of elbow injuries in children. Paediatric medial humeral epicondyle fracture management. Traditional teaching has been that medial epicondyle fractures may be. Operative versus nonoperative management of pediatric medial. The common origin of wrist flexors and medial collateral ligament attachments exert traction forces on the. Suture fixation of a medial epicondyle fracture vumedi. Management of supracondylar fractures of the humerus in. Males represent nearly threefourths of those injured, with a peak age of 1112 years. Although intraarticular incarceration of the medial epicondyle occurs. Closed treatment of condylar fractures by intermaxillary fixation with. It is a controversial topic in paediatric fracture management. Management of lateral humeral condylar mass fractures in children.
Operative treatment of displaced medial epicondyle fractures in. Functional loss with displacement of medial epicondyle. A thirteen year old gymnast with medial epicondyle fracture. Humeral medial epicondyle fracture management in the. Supracondylar humerus fractures pediatric orthopaedic. Medial epicondyle fractures, elbow dislocations, and. Lateral epicondyle fracture elbow radiology reference. Epicondylar plate fixation was associated with reduced complications compared with lag screws and kirschner wires p. There is ongoing debate about the surgical management of medial epicondyle fracture cases. The most common injury was avulsion fracture of the medial epicondyle. Epicondyle fracture elbow radiology reference article. Medial epicondyle fractures of the humerus account for 11%20% of all elbow injuries in children. Retain to maintain position while healing occurs by internal fixation, external fixation, or conservative methods 4.
Displaced medial epicondyle fractures of the humerus. Type 4 a controversial category describing a fracture that is unstable in flexion and extension, implying a lack of intact periosteum. Findings twelve studies consisting of treatment of avulsion fractures of the medial epicondyle, medial epicondyle fragmentation, olecranon stress fractures and olecranon apophysitis met criteria and were included in this study. Successful surgical management of a medial humeral. Impact of breed on canine humeral condylar fracture.
An undisplaced fracture line through the distal humerus andor a posterior fat pad sign may be present. The incidence rate of avulsion fracture of the medial epicondyle is 2536%, of the lateral condyle 4%, of the olecranon 1. This article describes the state of the evidence and the art in the management of medial humeral epicondyle fractures concentrating on recent research and current opinion. Surgical treatment for malunion of the lateral humeral. Pdf to assess treatment outcomes of young patients with medial epicondylar fracture of the elbow using standard operative protocols. Operative versus nonoperative management of pediatric. The use of a tensionband wire, instead of a screw, together with kirschner wires is the preferred treatment for younger children. Indication for a medial epicondyle orif is a fracture with a large displacement typically 5 mm of the bone. Paediatric medial epicondyle fractures of the distal humerus. Lameness was scored as 1 of 5 median in the 85 dogs with initial follow. Pdf there is ongoing debate about the management of medial epicondyle fractures in the pediatric.
The treatment results were all scored, and the patients with medial epicondylar fractures dis placement 5 mm showed good to excellent results with operative. Epicondyle fractures are common injuries in children. Pdf injuries of the medial epicondylar ossification. Fractures of the medial epicondyle represent 11 to 20% of elbow fractures. Rehabilitate r esuscitate advanced trauma life support. A posterolateral elbow dislocation was associated in 80 fractures. These injuries can coexist, such as in the case of elbow dislocations and medial epicondyle fractures. Lateral condylar mass lcm fractures of the distal humerus comprise 17% of distal humeral fractures and are the second most common injury around. Medial epicondyle fractures occur most commonly between ages 9 and 14 and account for up to 20% of all elbow fractures in children with a male to female preponderance of 4. These fractures are four times more common in boys. In type 1 fractures, the anterior humeral line passes through the middle third of the capitellum on the lateral radiograph. Nonsurgical management with a plaster cast has been used for many years but nonunion and thus valgus instability has been observed in 60% of cases, so that at present surgeons prefer surgical treatment with wire or screw fixation.
Medial humeral condyle fracture clinical presentation. Medial epicondylar fractures pediatric pediatrics orthobullets. A 24yearold righthanded man suffered right olecranon and lateral epicondylar fracture from high energy trauma. Lateral epicondyle fractures of the elbow are rare epicondylar fractures. In the pediatric population, medial humeral epicondylar fractures account for nearly 12% of all elbow fractures, with a notable proportion associated with elbow dislocations 1, 2. Abstract traditional management by cast immobilization increasingly is being replaced with early fixation and mobilization. The management of medial epicondyle fractures in the pediatric population has remained controversial with some studies showing positive results for both operative and nonoperative management. A new procedure for fractures of the medial epicondyle in. Medial epicondyle fractures comprise most of these injuries. Treatment of paediatric medial epicondylar fractures of the elbow remains the domain of expert opinion and subject to great variance. Stable fractures, where the alignment of the ankle joint is preserved, rarely need surgery. Medial epicondyle fractures are relatively common injuries in children and adolescents accounting for up to 20% of fractures about the elbow. Medial epicondyle fractures account for a significant portion of all elbow fractures, both acute and chronic, in the adolescent population. Medial epicondyle fractures represent almost all epicondyle fractures and occur when there is avulsion of the medial epicondyle.
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