Medial Condylar Fracture of the Elbow Clinical Presentation
- Author: John D Kelly, IV, MD; Chief Editor: Craig C Young, MD more...
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.
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.
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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