Medial epicondyle fracture (peds)

Background

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

Humerus Fractures

Clinical Features

  • Mechanisms:
  • Exam: pain with pronation or elbow/wrist flexion
  • May have associated ulnar nerve injury

Differential Diagnosis

Elbow Diagnoses

Radiograph-Positive

Radiograph-Negative

Pediatric

Evaluation

Workup

  • AP and lateral elbow x-ray
    • Consider comparison views of other elbow

Diagnosis

  • 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

Disposition

  • If nonoperative, follow up with pediatric orthopedist within 5-7 days

Specialty Care

  • Long arm cast with elbow flexed 90˚ vs operative management[1]

See Also

References

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