Medial Humeral Condyle Fracture

1. Pediatrics Case # 11

2. History and Physical 11 YOM presents with right elbow pain. Pt was playing on the trampoline with friends. He reports that while his right arm was planted someone fell onto the outer portion of his right elbow. He experienced immediate pain to the inner elbow. T 98.7 P 102 BP 126/84 O2 99% Gen: WDWN, obvious pain CV: Tachycardic , RR, no m/r/g Pulm : Lungs CTA bilat Musc : medial R elbow tenderness and swelling; lateral elbow in nontender ; decreased ROM 2/2 pain

3. X-ray

4. Diagnosis: Medial Epicondyle Fx of the Humerus

5. Pain Control Reduction/Stabilization Immobilize the elbow with the forearm in flexion and pronation of the wrist ED orthopedic consultation for fragment entrapment within the joint or ulnar neuropathy Orthopedic surgery follow up for re-evaluation and possible ORIF if displaced >5mm ED Management

6. Tends to occur in older children (10-14yo) Not a true Salter Harris injury (involves the apophysis rather than the physis ) Third most common elbow fx (5-10%, behind supracondylar and lateral epicondyle ) About half of medial epicondyle fractures are associated with elbow dislocation or subluxation Can occur from FOOSH or valgus stress Assess for ulnar neuropathy as ulnar nerve runs posterior to the condyle Major complication is entrapment of the fracture fragment within the elbow joint Pearls

7. Additional Image

8. http://www.hss.edu/conditions_elbow-fractures-children-overview.asp http://reference.medscape.com/features/slideshow/pediatric-fractures http://pediatricsportsmed.blogspot.com/2010/09/ucl-tear.html Tintinalli's Emergency Medicine: A Comprehensive Study Guide . Chapter 133 Musculoskeletal Disorders in Children. http://www.wheelessonline.com/ortho/medial_epicondyle_frx_of_the_humerus References