Executive Editor: Fergal Monsell

General Editor: Chris Colton

Authors: Andrew Howard, Theddy Slongo

Pediatric distal humerus 13-M/7M

General considerations

Avulsion of the medial epicondyle can be seen in isolation, but is also seen in association with an elbow dislocation in a child.

Undisplaced and minimally displaced (< 5 mm) fractures are treated with simple immobilization and with early motion to prevent stiffness, especially if there is an associated elbow dislocation.

Considerable variation in both practice and opinion exists regarding moderately displaced fractures (5-15 mm). Proponents of closed treatment describe excellent functional results and minimal pain, even if a fibrous union occurs.

Indications for open reduction include the degree of displacement. Many surgeons advocate internal fixation for children who participate in gymnastics and throwing sports. The precise degree of displacement that requires internal fixation has not been defined. CT scan studies show that true 3-D displacement cannot be accurately determined from plain radiographs.

Open reduction and internal fixation is mandatory if the medial epicondylar fragment is entrapped in the elbow joint. This is common after spontaneous, or manipulative, reduction of an elbow dislocation. Open reduction and internal fixation are also indicated for open fractures, or associated ulnar nerve lesions.

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v1.0 2016-12-01