Executive Editor: Chris Colton

Authors: Mariusz Bonczar, Daniel Rikli, David Ring

Distal humerus - Extraarticular, avulsion of medial epicondyle, incarcerated

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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, resulting from a valgus overload of the elbow.

At the moment of valgus opening of the medial side of the joint, the avulsed fragment may be pulled into the joint and become trapped (incarcerated), as the valgus deformity tends to reduce.

All incarcerated fragments require surgical reduction and fixation.

Internal fixation of these fragments helps to restore elbow stability.

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

Pediatric fractures are considered in Pediatric trauma of Surgery Reference.

ORIF - Screw fixation
Indication summary Skill Equipment
Surgery always indicated Highly experienced and skilled surgeon Simple surgical and imaging resources

In these fractures surgery is always indicated.

Contraindications

  • Age
  • Unacceptable surgical risk
  • Noncompliant patient
*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