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Medial Condylar Fracture of the Elbow Follow-up

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

Return to Play

Prior to returning to athletic competition, the participant should regain normal or near-normal strength in the affected arm and range of motion should be similar to the preinjury status. However, some athletes may be able to return to competitive sports prior to reaching these goals. This depends on the type of sport (ie, contact vs noncontact) and whether the injury affected the athlete's dominant or nondominant arm. Athletes returning to sports that require elbow-loading maneuvers (eg, gymnastics) often require more extensive rehabilitation prior to returning to competition. The use of bracing, to protect the elbow against valgus loads, is recommended for rigorous sports if return to play occurs before 6 months postinjury.

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Complications

Delayed complications occur with a reasonably high frequency.

Limited flexion and extension is a complication that can occur with medial condylar fractures. Heterotopic ossification may occur and is related to trauma to the brachialis muscle. Usually, pronation or supination is not limited. Mild limitations of elbow movement are usually well tolerated from a functional standpoint.

Cubitus varus (gun stock deformity) can occur and may be the result of decreased growth of the trochlea. This complication may be more likely to occur in displaced fractures that receive no initial treatment.

Cubitus valgus deformities also can occur and appear to be due to secondary stimulation or overgrowth of the medial condyle fracture fragment.

Nonunion/pseudoarthrosis of the fracture fragment can occur as a complication of medial condylar fractures in children. This may be related to the precarious blood supply of the distal fragment and because fractures that traverse the physeal plate are inherently less stable. Kakar et al reported that the vascularized medial femoral condyle corticoperiosteal flap offers another treatment option for humeral nonunions.[4]

Posttraumatic arthritis due to chondral injury or residual joint incongruity may occur; it usually manifests several years later. Avascular necrosis may ensue because of the poor vascularity of this area and has been reported for even nondisplaced fractures.

A retrospective study reported the clinical and functional outcomes and the complications that occurred following open reduction and screw fixation of medial epicondyle fractures with intra-articular fragment incarceration. The study concluded that open reduction and screw fixation yielded excellent clinical and functional outcomes for the treatment of medial epicondyle fractures with intra-articular fragment incarceration. The authors also added that particular attention should be paid when treating these potentially serious injuries in order to minimize the risk of possible complications.[5]

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Prevention

Because these injuries occur as a result of accidental falls or participation in high-risk sports, prevention is difficult. Proper education and adequate protective gear (eg, elbow padding) should decrease the likelihood of these injuries occurring.

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Prognosis

The outcome of medial condylar fractures depends on the degree of comminution of the fracture, the accuracy of the reduction, and the stability of fixation of the fracture fragment restoring congruity of the articular surface.

In general, nondisplaced fractures that are managed conservatively with a long arm cast have excellent results. In displaced fractures that require open reduction and internal fixation, a good outcome can be expected, with results paralleling the quality of reduction.

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Education

For excellent patient education resources, visit eMedicineHealth's First Aid and Injuries Center. Also, see eMedicineHealth's patient education articles Broken Arm and Elbow Dislocation.

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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
  1. Louahem DM, Bourelle S, Buscayret F, et al. Displaced medial epicondyle fractures of the humerus: surgical treatment and results. A report of 139 cases. Arch Orthop Trauma Surg. 2009 Dec 4. [Medline].

  2. Kamath AF, Cody SR, Hosalkar HS. Open reduction of medial epicondyle fractures: operative tips for technical ease. J Child Orthop. 2009 Aug. 3(4):331-6. [Medline]. [Full Text].

  3. Martín JR, Mazzini JP. Posterolateral elbow dislocation with entrapment of the medial epicondyle in children: a case report. Cases J. 2009 Jul 27. 2:6603. [Medline]. [Full Text].

  4. Kakar S, Duymaz A, Steinmann S, Shin AY, Moran SL. Vascularized medial femoral condyle corticoperiosteal flaps for the treatment of recalcitrant humeral nonunions. Microsurgery. 2011 Feb. 31(2):85-92. [Medline].

  5. Tarallo L, Mugnai R, Fiacchi F, Adani R, Zambianchi F, Catani F. Pediatric medial epicondyle fractures with intra-articular elbow incarceration. J Orthop Traumatol. 2014 Jul 26. [Medline].

  6. Bensahel H, Csukonyi Z, Badelon O, Badaoui S. Fractures of the medial condyle of the humerus in children. J Pediatr Orthop. 1986 Jul-Aug. 6(4):430-3. [Medline].

  7. Flynn JM, Sarwark JF, Waters PM, Bae DS, Lemke LP. The surgical management of pediatric fractures of the upper extremity. Instr Course Lect. 2003. 52:635-45. [Medline].

  8. 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].

  9. Geiderman JM, Magnusson AR. Humerus and elbow. Rosen P, Barkin R, eds. Emergency Medicine Concepts and Clinical Practice. 4th ed. St. Louis, Mo: Mosby-Year Book; 1998. 690-708.

  10. Ghawabi MH. Fracture of the medial condyle of the humerus. J Bone Joint Surg Am. 1975 Jul. 57(5):677-80. [Medline].

  11. Green NE, Swiontkowski MF, eds. Fractures and dislocations about the elbow. Skeletal Trauma in Children. 2nd ed. Philadelphia, Pa: WB Saunders Co; 1998. 294-301.

  12. 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].

  13. Lins RE, Simovitch RW, Waters PM. Pediatric elbow trauma. Orthop Clin North Am. 1999 Jan. 30(1):119-32. [Medline].

  14. Nirschl RP, Kraushaar BS. Assessment and treatment guidelines for elbow injuries. Phys Sports Med. May 1996. 24(5):43-60.

  15. Papavasiliou V, Nenopoulos S, Venturis T. Fractures of the medial condyle of the humerus in childhood. J Pediatr Orthop. 7(4):421-3. [Medline].

  16. Simon RR, Koenigsknecht SJ. Distal humerus. Emergency Orthopedics. 3rd ed. Stamford, Conn: Appleton & Lange; 1995. 147-168.

  17. Tanno M, Tanaka H, Mukai E, Hayashi Y, Takenouchi K. [Supracondylar and condylar fracture of the humerus]. Clin Calcium. 2008 Sep. 18(9):1332-8. [Medline].

  18. Tsai AK, Ruiz E. The elbow joint. Ruiz EE, Cicero JJ, eds. Emergency Management of Skeletal Injuries. St. Louis, Mo: Mosby-Year Book; 1995. 221-250.

  19. Wilkins KE. Fractures and dislocations of the elbow region. Rockwood CA, Wilkins KE, King RE, eds. Fractures in Children. 3rd ed. Philadelphia, Pa: JB Lippincott; 1991. 509-828.

 
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Milch classification of condylar fractures.
Medial epicondylar fracture
 
 
 
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