Diagnosis

Extraarticular avulsion fracture 

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1. Avulsion of lateral epicondyle 
2. Avulsion of medial epicondyle 
3. Avulsion of medial epicondyle, incarcerated 

1. Avulsion of lateral epicondyle 

Avulsion of lateral epicondyle

This fracture type is classified by the AO/OTA as 13A1.1.

This is an avulsion fracture of the lateral epicondyle. By definition, there is no involvement of the joint (capitellum).
The fracture is the equivalent of an avulsion of the humeral attachment of the lateral collateral ligament.
Typically, this injury occurs in young patients.

The fragment may become incarcerated in the lateral elbow joint cavity (see x-ray below).

To avoid varus instability of the elbow, the fragment should be fixed.

Avulsion of lateral epicondyle

Image taken from Orozco R, et al. (1998) Atlas of Internal Fixation. Used with kind permission.

2. Avulsion of medial epicondyle 

Avulsion of medial epicondyle

This fracture type is classified by the AO/OTA as 13A1.2.

It is not uncommon for an elbow dislocation in a skeletally immature patient to be associated with a medial epicondyle fracture.
Medial epicondyle fractures are more common in skeletally immature patients.

Avulsion of medial epicondyle

3. Avulsion of medial epicondyle, incarcerated 

Avulsion of medial epicondyle, incarcerated

In rare cases, the fragment is incarcerated in the humero-ulnar joint.

There is no place for nonoperative treatment of incarcerated fragments, unless general contraindications to surgery are present.

Avulsion of medial epicondyle, incarcerated