Medial epicondyle fracture (peds): Difference between revisions
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==Management== | ==Management== | ||
*Reduction, if concurrent [[elbow dislocation]] | |||
*[[Posterior long-arm splint]] with forearm pronated | |||
*Ortho consult | *Ortho consult | ||
**Long arm cast with elbow flexed 90˚ vs operative management<ref>https://www.orthobullets.com/pediatrics/4008/medial-epicondylar-fractures--pediatric</ref> | **Long arm cast with elbow flexed 90˚ vs operative management<ref>https://www.orthobullets.com/pediatrics/4008/medial-epicondylar-fractures--pediatric</ref> | ||
Revision as of 21:30, 22 June 2020
Background
- Not true Salter-Harris fracture (apophysis, not physis, is involved)
- 50% associated with elbow dislocation
Humerus Fracture Types
Clinical Features
- Mechanisms:
- Posterior elbow dislocation
- Repetitive stress ("Little League elbow")
- Exam: pain with pronation or elbow/wrist flexion
- May have associated ulnar nerve injury
Differential Diagnosis
Elbow Diagnoses
Radiograph-Positive
- Distal humerus fracture
- Radial head fracture
- Capitellum fracture
- Olecranon fracture
- Elbow dislocation
Radiograph-Negative
- Biceps tendon rupture/dislocation
- Lateral epicondylitis
- Medial epicondylitis
- Olecranon bursitis (nonseptic)
- Pronator teres syndrome
- Septic bursitis
Pediatric
- Nursemaid's elbow
- Supracondylar fracture
- Lateral epicondyle fracture
- Medial epicondyle fracture
- Olecranon fracture
- Radial head fracture
- Salter-Harris fractures
Evaluation
- Displacement of medial epicondyle ossification center
- May become entrapped within elbow joint
- Use CRITOE to determine if bone in joint is medial epicondyle or normal trochlear osseus center
- If think is trochlear but cannot see medial epicondyle fragment is medial epicondyle
- (Medial epicondyle normally ossifies before the trochlea)
- If think is trochlear but cannot see medial epicondyle fragment is medial epicondyle
- Fat pad sign not usually present because most injuries are extra-articular
Management
- Reduction, if concurrent elbow dislocation
- Posterior long-arm splint with forearm pronated
- Ortho consult
- Long arm cast with elbow flexed 90˚ vs operative management[1]