Executive Editor: Chris Colton

Authors: Mariusz Bonczar, Daniel Rikli, David Ring

Distal humerus - Extraarticular, avulsion of medial epicondyle

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Glossary

General considerations

These fractures represent avulsion of the humeral origin of the medial collateral ligamentous complex of the elbow joint.

Take particular note to exclude valgus compression fracture of the radial head or the capitellum.

Any significant fragment displacement should raise suspicion of valgus instability of the elbow.

Internal fixation of these fragments helps to restore elbow stability.

Pediatric fractures are considered in Pediatric trauma of Surgery Reference.

Nonoperative treatment
Indication summary Skill Equipment
Minimally displaced or patient not fit for surgery Basic surgical experience, no specialized skills Basic equipment only

Indications

  • Small fragment not influencing stability
  • Minimal or no displacement, especially distally
  • Unacceptable surgical risk

Contraindications

  • Joint instability
  • Large fragment
  • Displacement
  • Joint incarceration
  • Ulnar nerve deficit

Advantages

  • No scarring
  • Non-invasive
  • Inexpensive
  • Delayed surgery is possible

Disadvantages

  • Immobilization
  • Subsequent stiffness of the joint
  • Patient discomfort
ORIF - Screw fixation
Indication summary Skill Equipment
Any significant displacement. Valgus instability of elbow. Ulnar nerve compromise Some specialized surgical experience Simple surgical and imaging resources

Indications

  • Open fracture
  • Large fragment
  • Joint instability
  • Displacement
  • Ulnar nerve deficit

Contraindications

  • Age
  • Unacceptable surgical risk
  • Noncompliant patient

Advantages

  • Accurate reduction
  • Early functional aftertreatment
  • Reduced risk of joint stiffness
  • Restoration of joint stability
  • Nerve protection

Disadvantages

  • Invasive
  • Risk of infection
  • Often scar sensitivity
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2007-06-21