Deformity after internal fixation of fracture separation of the medial epicondyle of the humerus

Abstract

We reviewed 24 displaced fractures through the physis of the medial epicondyle of the distal humerus. One was a Salter-Harris type-II fracture-separation of the whole distal humeral epiphysis; the others involved only the medial epicondylar centre of ossification. Two cases had presented as pseudarthroses. One fracture had been treated closed in a plaster slab and 21 had had open reduction and internal fixation with sutures, Kirschner wires or Palmer nails. At 2 to 13 years later we found five types of deformity of the epicondyle: pseudarthrosis, an ulnar sulcus, a double-contoured epicondyle, hypoplasia or hyperplasia. Pseudarthrosis had developed after either no treatment, closed reduction and plaster, or open reduction and suturing. Hypoplasia followed nailing, as did a trend to varus tilting of the joint surface. One very young patient, with fracture-separation of the whole distal epiphysis treated by nailing, developed marked cubitus varus.

Conservative treatment of posterolateral dislocation of the elbow with medial epicondyle fracture in children between 6 and 8 years old

“…24, 26 An avulsion of the medial epicondyle seen on the X-ray in a patient between 6 and 8 years of age, may encrypt an associated fracture of the trochlea (Salter-Haris I or III). 24,26 Although the capitellum has appeared radiologically at that age (usually since the age of Conservative treatment of posterolateral dislocation of the elbow 419 4), trochlea is not visible yet. This makes it difficult to assess the post-traumatic anatomy of the region.…”

“…An avulsion fracture of the medial epicondyle may thus accompany a more extensive fractureseparation including the medial condyle. 18,24 This type of injury that associates posterolateral elbow dislocation with a medial condyle fracture, although extremely rare, should also be excluded. 22 The necessity of a thorough clinical examination and evaluation of the elbow before deciding the treatment approach is thus, beyond all dispute.…”

“…However, the medial epicondyle is an apophysis and does not contribute to the longitudinal growth of the humerus. 24 Consequently, given that no injury of the trochlea is apparent, no physeal arrest will affect the excellent functional results of closed treatment.…”

“…At that age, radiographic evaluation becomes harder and a concomitant fracture separation of the condyle can easily be misquoted. 7,24 The purpose of this paper is to present our experience with three children, between 6 and 8 years of age, that sustained such an injury and were treated conservatively.…”

Unrecognized fracture of the medial epicondylar apophysis of the humerus

“…There are few reports about injury to an unossified medial epicondyle. Skak et al 12 reported one case of this fracture that became apparent 3 months after injury and developed into a pseudoarthrosis. May et al 10 also reported an unossified medial epicondyle avulsion that was diagnosed with sonography.…”