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