Executive Editor: Fergal Monsell General Editor: Chris Colton

Authors: Andrew Howard, Theddy Slongo

Pediatric distal humerus 13-E/7L

back to Pediatric overview


1 Goals and principles top


The main goals for treatment (nonoperative or operative) of these ligament injuries are:

  • Restoration of elbow stability
  • Prevention of nonunion of the epicondyle
  • Prevention of secondary displacement



The main principles of treatment for these displaced injuries are:

  • To achieve reduction and stable fixation
  • Restoration and maintenance of elbow stability

Note: The lateral humeral epicondyle is intracapsular.

2 Preparation top


Instruments and implants

A double-tipped K-wire of appropriate size (1.0-1.25 mm), depending on the size of the fragment.


Anesthesia and positioning

General anesthesia is recommended and a sterile tourniquet should be available.

The patient is placed supine with the arm draped up to the shoulder.

See also the additional material on preoperative preparation.

3 Approach top


A standard lateral approach to the elbow is used.

As the lateral epicondyle is visualized the following can be seen:

  • In younger children with an isolated cartilage avulsion, the amount of bleeding is minimal
  • In older children with a bony avulsion, bleeding is visible from the site of avulsion

Note: In these illustrations, the extensor muscle group is represented by only one muscle.

4 K-wire fixation top


The avulsed ligament and bony fragment are orientated to provide a direct view of the fracture surface.

One or two retrograde double ended K-wires are passed through the fragment, from inside out, as illustrated.


The fragment is then reduced under direct vision and the wire(s) advanced, avoiding the olecranon fossa and the physis.


The wire is bent over, cut and embedded using a punch.

See also the additional material on K-wire principles.

v1.0 2016-12-01