Executive Editor: Fergal Monsell General Editor: Chris Colton

Authors: Andrew Howard, Theddy Slongo

Pediatric distal humerus 13-M/7M

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1 Introduction top


The medial epicondyle fracture is an avulsion fracture of the apophysis and often accompanies elbow dislocation. Closed reduction of the medial epicondyle is most successful if done at the time of reduction of the elbow dislocation itself.

If the medial epicondylar fragment is trapped in the joint, open reduction is often necessary, although the following closed reduction maneuver can be attempted.

The main soft tissue attachments of the medial epicondyle are the flexor-pronator muscles of the forearm. These remain attached to the fragment and can be used to aid closed reduction.

Percutaneous fixation is not recommended due to vulnerability of the ulnar nerve.

2 Closed extraction of the medial epicondyle from the elbow top


With the elbow near full extension, a gentle valgus force is applied to open the medial side of the joint.


The fingers and wrist are fully extended, while the forearm is fully supinated.

This causes the flexor-pronator mass to pull the medial epicondyle away from the elbow joint.

The elbow joint itself is then reduced by longitudinal traction followed by flexion.

A complete and congruent reduction of the radiocapitellar and humeroulnar articulations, as well as the position of the medial epicondyle, are assessed using image intensification.

3 Immobilization top


If reduction of the fracture is acceptable, the arm is immobilized in a splint at 90° flexion for no more than 10-14 days.

v1.0 2016-12-01