Epicondyle Fractures

Lateral epicondyle fractures almost never occur, since the anatomic position of the condyle reduces the exposure to direct blows resulting instead in fractures of the lateral condyle. When they do occur, these fractures are usually avulsion fractures and may be treated by immobilization with the elbow flexed to 90° and the forearm in supination. The patient is referred to an orthopedist within 1 week.

Medial epicondyle fractures are more common and tend to occur in the pediatric and adolescent populations. The mechanism of injury is usually a posterior elbow dislocation with avulsion of a fragment of the medial epicondyle. In adults, the mechanism is from a direct blow to the prominent medial epicondyle. Examination reveals swelling and tenderness medially, and pain with flexion of the elbow or wrist from the forearm flexors. A careful search must be made of the radiographs to determine whether the fracture fragment is carried into the joint space after reduction of an elbow dislocation ( Fig 2.61-3.).

Undisplaced and minimally displaced fractures are treated with a long-arm posterior splint with the forearm pronated and elbow and wrist flexed. The patient is referred to an orthopedist within 1 week, and early active ROM is begun. Fracture fragments entrapped within the joint require surgical removal if closed attempts are unsuccessful. Displaced fractures may be treated either surgically or by closed manipulation. These patients are splinted as described, and an acute referral is made to an orthopedist. Since the trochlea does not appear as an ossification center until after age 10 to 12 years, one must be mindful that a displaced medial condyle fracture may be associated with a significant trochlear fracture.

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