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Medial Condylar Fracture of the Elbow Clinical Presentation

  • Author: John D Kelly, IV, MD; Chief Editor: Craig C Young, MD  more...
 
Updated: Mar 18, 2015
 

History

When evaluating a patient with an acute elbow injury, obtain a detailed event history including the injury mechanism and the quality, intensity, duration, and location of symptoms.

  • Injuries to the upper extremity, specifically the elbow, are often caused by falling on an outstretched arm, with the elbow in extension and the wrist in dorsiflexion. This type of injury can cause the medial condyle of the elbow to be avulsed as a result of ligamentous and muscular forces.
  • Another mechanism responsible for medial condylar fractures is falling onto the point of a flexed elbow. The direct force applied to the posterior aspect of the elbow causes the articular portion of the olecranon to push the medial condyle off the distal humerus.

Elicit and document hand dominance, occupation, and preexisting extremity injury.

Also obtain a history of neurovascular complaints (eg, paresthesias, weakness, numbness, coolness). Neurologic complaints associated with acute elbow trauma suggest a neurapraxia, nerve entrapment syndrome, or compartment syndrome.

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Physical

Visual inspection is often the first step in assessing a patient with a traumatically injured elbow.

Evaluate all injured patients in a systematic fashion as described in the Advanced Trauma Life Support provider's manual. The athletic trainer or examining physician should be aware of the possibility of a proximal upper extremity injury (ie, fracture, dislocation) in patients who have fallen onto an outstretched upper extremity.

Systematically perform the physical examination of an acutely injured extremity. In the patient with an acutely injured elbow, evaluation of the extremity can begin at the shoulder and upper arm and then proceed to the forearm, wrist, and hand. The elbow should be examined last because tenderness elicited may interfere with a proper examination of the injured extremity.

Assess the vascular status of the extremity. Palpate brachial, radial, and ulnar pulses. Evaluate the injured extremity for signs and symptoms of a compartment syndrome, including pain out of proportion to the injury, severe forearm pain with passive extension of the fingers, pallor, paresthesia, pulselessness, and paralysis.

Test neurologic function. Perform distal motor and sensory testing of the radial, median, and ulnar nerves.

  • Radial nerve testing
    • Motor function of the radial nerve can be assessed by testing finger extension, which is primarily a function of the C7 nerve root.
    • Sensory testing can be performed over the dorsal web space between the first and second digits.
  • Median nerve testing
    • Motor function of the medial nerve can be assessed by testing finger flexion, which is primarily a function of the C8 nerve root.
    • Sensory testing can be performed over the radial aspect of the second digit.
  • Ulnar nerve testing
    • Motor function of the ulnar nerve can be assessed by testing finger abduction, which is primarily a function of the T1 nerve root.
    • Sensory testing can be performed over the ulnar aspect of the fifth digit.

Range-of-motion testing prior to radiographic evaluation should be minimized in the acutely painful extremity, especially in children.

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Causes

Medial condylar fractures generally occur as a result of (1) a fall onto an outstretched upper extremity or (2) a fall onto a flexed elbow. The mechanism of injury appears to be the same in both children and adults.

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Contributor Information and Disclosures
Author

John D Kelly, IV, MD Associate Professor, Department of Orthopedic Surgery, University of Pennsylvania, Attending Surgeon Pennsylvania Hospital, Veterans Adminsitration Hospital

John D Kelly, IV, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Eastern Orthopaedic Association, Pennsylvania Orthopaedic Society, Philadelphia County Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

David Wald, DO, FACOEP Assistant Program Director, Assistant Professor, Department of Medicine, Division of Emergency Medicine, Temple University School of Medicine

David Wald, DO, FACOEP is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Henry T Goitz, MD Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Leslie Milne, MD Assistant Clinical Instructor, Department of Emergency Medicine, Harvard University School of Medicine

Leslie Milne, MD is a member of the following medical societies: American College of Sports Medicine

Disclosure: Nothing to disclose.

References
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Milch classification of condylar fractures.
Medial epicondylar fracture
 
 
 
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