Pediatric Fractures of the Hand, Wrist, Forearm, and Elbow-Case: Medial Epidoncyle Fractures

Case: Medial Epidoncyle Fractures

Pdf Summary

This summary discusses medial epicondyle fractures, focusing on treatment options and key points about the condition. It begins by describing the case of an 11-year-old female gymnast who injured her elbow. The article explains that there is some controversy surrounding the treatment of these fractures, but provides absolute indications for treatment, such as incarcerated medial epicondyle fragments in the joint or open fractures. Relative indications include high-energy injury or dislocation, ulnar neuropathy, and significant displacement. The article also mentions that plain radiographs can be deceiving, as "nondisplaced" fractures on these images may actually be displaced on CT scans. A new view called the "distal humerus axial X-ray" can show the amount of anterior displacement. The chosen treatment for the gymnast in the case study was open reduction and internal fixation (ORIF). The patient was placed in a prone position, which facilitated the ease of reduction. One wire was used for de-rotation, and a center wire was placed for the desired screw position. The treatment is illustrated in AP and lateral intraoperative films showing the posterior-to-anterior trajectory of the screw. Finally, the summary provides key points about medial epicondyle fractures, explaining that they are commonly caused by a fall onto an outstretched arm with valgus stress. Displacement of the medial epicondyle is attributed to the strong forearm flexor attachments. Nondisplaced or minimally displaced fractures may be treated nonoperatively with a splint or long arm cast, but have high rates of nonunion.

Keywords

medial epicondyle fractures

treatment options

absolute indications

open fractures

relative indications

CT scans

open reduction and internal fixation

prone position

nondisplaced fractures

nonoperative treatment