Medial Humeral Condyle Fracture Workup
- Author: John J Walsh, IV, MD; Chief Editor: Harris Gellman, MD more...
No laboratory tests are indicated for the diagnosis of a fracture, though they may be necessary for preoperative clearance.
Diagnosis is usually based on standard anteroposterior (AP) and lateral radiographs of the affected elbow (see the images below).[8, 16, 29, 30]
Distinguishing a fracture of the medial epicondyle (see the image below) from a fracture of the medial condyle can be difficult in the developing elbow.[2, 3, 4, 5, 6, 7, 8, 9, 30] Because cartilaginous structures are usually not visible radiographically, the exact location of injury may not be obvious. With its complicated and variable pattern of ossification, trauma to this region presents a difficult diagnostic challenge.
Because the medial epicondyle lies largely outside the joint capsule, fractures of this structure usually do not produce distention of the joint capsule. Therefore, if a positive fat-pad sign accompanies soft-tissue swelling, fracture extension distally into the joint capsule to include the trochlear ossification center and medial condyle should be considered.
Radiographic clues to unstable medial condyle fracture in a young child include soft-tissue swelling, a chip or flake of bone from the metaphysis, and the presence of a positive fat-pad sign.
In slightly displaced or nondisplaced fractures of the medial epiphysis, widening or irregularity of the apophyseal physis may be the only sign. If the medial epiphysis is absent, the fragment may be incarcerated totally into the joint or hidden by the overlying ulnar or distal humerus.
The lack of a fat-pad sign cannot be used to exclude medial condyle injury. If the joint capsule is ruptured, no fat-pad sign is exhibited. Therefore, it may be necessary to examine the elbow under anesthesia to determine whether instability is present that would indicate a more extensive injury.
A widely displaced fracture-separation of the medial epicondyle in a patient whose trochlear ossification center has not yet appeared can indicate that the cartilaginous trochlea may also be fractured and attached to the epicondyle. This possibility should be considered and may warrant surgical exploration.
Arthrography may be used to determine the extent of a fracture and to help distinguish an epicondyle fracture from a condyle fracture.
Magnetic resonance imaging (MRI) may be used to evaluate soft-tissue injury and may be helpful in evaluating cartilaginous injury.
Interobserver and intraobserver reliability is poor for the use of plain radiography to assess epicondyle displacement. Three-dimensional computed tomography (CT) is a more accurate means of evaluating displacement of an epicondylar fragment; indeed, plain films may underestimate displacement by up to 1 cm.
Rockwood CA, Wilkins KE, Beaty JH. Apophyseal injuries of the distal humerus. Fractures in Children. 3rd ed. Philadelphia: Lippincott-Raven; 1996. 800-19.
Behrman MJ, Shelton ML. Fracture of the medial condyle of the humerus in an elderly patient. J Orthop Trauma. 1990. 4(1):98-101. [Medline].
Bensahel H, Csukonyi Z, Badelon O. Fractures of the medial condyle of the humerus in children. J Pediatr Orthop. 1986 Jul-Aug. 6(4):430-3. [Medline].
Chacha PB. Fracture of the medical condyle of the humerus with rotational displacement. Report of two cases. J Bone Joint Surg Am. 1970 Oct. 52(7):1453-8. [Medline].
Fahey JJ, O'Brien ET. Fracture-separation of the medial humeral condyle in a child confused with fracture of the medial epicondyle. J Bone Joint Surg Am. 1971 Sep. 53(6):1102-4. [Medline].
Fowles JV, Kassab MT. Displaced fractures of the medial humeral condyle in children. J Bone Joint Surg Am. 1980 Oct. 62(7):1159-63. [Medline].
Ghawabi MH. Fracture of the medial condyle of the humerus. J Bone Joint Surg Am. 1975 Jul. 57(5):677-80. [Medline].
Mirsky EC, Karas EH, Weiner LS. Lateral condyle fractures in children: evaluation of classification and treatment. J Orthop Trauma. 1997 Feb-Mar. 11(2):117-20. [Medline].
Papavasiliou V, Nenopoulos S, Venturis T. Fractures of the medial condyle of the humerus in childhood. J Pediatr Orthop. 1987 Jul-Aug. 7(4):421-3. [Medline].
Varma BP, Srivastava TP. Fracture of the medial condyle of the humerus in children: a report of 4 cases including the late sequelae. Injury. 1972 Nov. 4(2):171-4. [Medline].
De Boeck H, De Smet P, Penders W. Supracondylar elbow fractures with impaction of the medial condyle in children. J Pediatr Orthop. 1995 Jul-Aug. 15(4):444-8. [Medline].
Leet AI, Young C, Hoffer MM. Medial condyle fractures of the humerus in children. J Pediatr Orthop. 2002 Jan-Feb. 22(1):2-7. [Medline].
Louahem DM, Bourelle S, Buscayret F, Mazeau P, Kelly P, Dimeglio A, et al. Displaced medial epicondyle fractures of the humerus: surgical treatment and results. A report of 139 cases. Arch Orthop Trauma Surg. 2010 May. 130(5):649-55. [Medline].
Pathy R, Dodwell ER. Medial epicondyle fractures in children. Curr Opin Pediatr. 2015 Feb. 27 (1):58-66. [Medline].
Patel NM, Ganley TJ. Medial epicondyle fractures of the humerus: how to evaluate and when to operate. J Pediatr Orthop. 2012 Jun. 32 Suppl 1:S10-3. [Medline].
McCarthy SM, Ogden JA. Radiology of postnatal skeletal development. V. Distal humerus. Skeletal Radiol. 1982 Jan. 7(4):239-49. [Medline].
Moore KL. Clinically Oriented Anatomy. 3rd ed. Philadelphia: Williams & Wilkins; 1992.
Dellon AL, Ducic I, Dejesus RA. The innervation of the medial humeral epicondyle: implications for medial epicondylar pain. J Hand Surg [Br]. 2006 Jun. 31(3):331-3. [Medline].
Oh CW, Park BC, Ihn JC. Fracture separation of the distal humeral epiphysis in children younger than three years old. J Pediatr Orthop. 2000 Mar-Apr. 20(2):173-6. [Medline].
Ip D, Tsang WL. Medial humeral epicondylar fracture in children and adolescents. J Orthop Surg (Hong Kong). 2007 Aug. 15(2):170-3. [Medline].
Ngom G, Fall I, Sy MH, Dieme C, Ndoye M. [Fractures of the medial humeral epicondyle in child: preliminary study about 18 cases]. Dakar Med. 2003. 48(3):199-201. [Medline].
Babal JC, Mehlman CT, Klein G. Nerve injuries associated with pediatric supracondylar humeral fractures: a meta-analysis. J Pediatr Orthop. 2010 Apr-May. 30(3):253-63. [Medline].
Landin LA, Danielsson LG. Elbow fractures in children. An epidemiological analysis of 589 cases. Acta Orthop Scand. 1986 Aug. 57(4):309-12. [Medline].
Saraf SK, Tuli SM. Concomitant medial condyle fracture of the humerus in a childhood posterolateral dislocation of the elbow. J Orthop Trauma. 1989. 3(4):352-4. [Medline].
Milch H. Fractures and fracture dislocations of the humeral condyles. J Trauma. 1964 Sep. 15:592-607. [Medline].
Kilfoyle RM. Fractures of the medial condyle and epicondyle of the elbow in children. Clin Orthop. 1965 Jul-Aug. 41:43-50. [Medline].
Farsetti P, Potenza V, Caterini R. Long-term results of treatment of fractures of the medial humeral epicondyle in children. J Bone Joint Surg Am. 2001 Sep. 83-A(9):1299-305. [Medline].
Skaggs DL. Elbow Fractures in Children: Diagnosis and Management. J Am Acad Orthop Surg. 1997 Nov. 5 (6):303-312. [Medline].
Harrison RB, Keats TE, Frankel CJ. Radiographic clues to fractures of the unossified medial humeral condyle in young children. Skeletal Radiol. 1984. 11(3):209-12. [Medline].
Yates C, Sullivan JA. Arthrographic diagnosis of elbow injuries in children. J Pediatr Orthop. 1987 Jan-Feb. 7(1):54-60. [Medline].
Pappas N, Lawrence JT, Donegan D, Ganley T, Flynn JM. Intraobserver and interobserver agreement in the measurement of displaced humeral medial epicondyle fractures in children. J Bone Joint Surg Am. 2010 Feb. 92(2):322-7. [Medline].
Edmonds EW. How displaced are "nondisplaced" fractures of the medial humeral epicondyle in children? Results of a three-dimensional computed tomography analysis. J Bone Joint Surg Am. 2010 Dec 1. 92(17):2785-91. [Medline].
Dodds SD, Flanagin BA, Bohl DD, DeLuca PA, Smith BG. Incarcerated medial epicondyle fracture following pediatric elbow dislocation: 11 cases. J Hand Surg Am. 2014 Sep. 39 (9):1739-45. [Medline].
Tarallo L, Mugnai R, Fiacchi F, Adani R, Zambianchi F, Catani F. Pediatric medial epicondyle fractures with intra-articular elbow incarceration. J Orthop Traumatol. 2015 Jun. 16 (2):117-23. [Medline].
Karlsson MK, Herbertsson P, Nordqvist A, Besjakov J, Josefsson PO, Hasserius R. Comminuted fractures of the radial head. Acta Orthop. 2010 Apr 3. [Medline].
Haxhija EQ, Mayr JM, Grechenig W. [Treatment of medial epicondylar apophyseal avulsion injury in children]. Oper Orthop Traumatol. 2006 Jun. 18(2):120-34. [Medline].
Hoppenfeld S, Murthy VL. Treatment and Rehabilitation of Fractures. Philadelphia: Lippincott Williams & Wilkins; 2000.