Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Medial Condylar Fracture of the Elbow Workup

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

Laboratory Studies

Laboratory studies are not generally indicated for diagnosing condylar fractures of the elbow.

Next

Imaging Studies

Radiography

  • Standard elbow radiographs, which include anteroposterior and lateral projections, are often sufficient to diagnose a fracture in the acutely injured elbow. Additional views (eg, oblique projections) are rarely required.
  • The decision to obtain elbow radiographs is based on the history of the injury and the physical examination findings from the patient. Clinical decision rules, such as the Ottawa ankle and foot rules (commonly used in emergency medicine), that help identify which patients with acute traumatic elbow injuries need radiographs have not yet been developed.
  • Radiographs should be performed on patients who exhibit joint swelling and tenderness of the bony landmarks, crepitus, or restricted and painful range of motion of the elbow following trauma.
  • In condylar fractures, the radiograph typically reveals widening of the intercondylar distance. Although the fracture fragment may be displaced proximally, it is generally seen inferior and posterior to its normal position.
  • In young children, medial condylar fractures may be difficult to diagnose radiographically if the injury occurs before ossification of the trochlea. Clinically and radiographically, the injury may be misinterpreted as a fracture of the medial epicondyle.
  • In older children, a metaphyseal fragment may be visualized, indicating condylar involvement. The presence of a pathologic fat pad, either a large anterior fat pad (sail sign) or a posterior fat pad, often indicates an intra-articular injury. Isolated fractures of the medial epicondyle are extra-articular injuries and are not commonly associated with the presence of a posterior fat pad sign. In the clinical context of acute elbow trauma without an obvious fracture on the radiograph, a pathologic fat pad is often associated with the presence of an occult fracture.
  • Plain films may be difficult to interpret in pediatric patients, and comparison views of the uninjured extremity may help to differentiate a fracture from a secondary ossification center.
  • Radiographically, medial condylar fractures are classified the same as lateral condylar fractures. Fracture classification is primarily based on the location of the fracture line. In adults, Milch classifies medial condylar fractures into 2 types (type I or type II) depending on whether the lateral wall of the trochlea remains attached to the humerus.
    • Type I fractures are more common. In this type of injury, the fracture line originates at the depth of the trochlear groove and ascends obliquely toward the supracondylar ridge. In type I fractures, the lateral trochlear ridge remains with the intact condyle, maintaining mediolateral stability.
    • Type II fractures originate in the capitulotrochlear sulcus, thus leading to mediolateral instability of the elbow.
  • The Milch classification can also be applied to pediatric medial condylar fractures.
    • A Milch type I fracture is a Salter-Harris type II fracture. In this injury, the fracture line runs between the common physeal line, separating the medial and lateral condylar ossification centers.
    • A Milch type II fracture is a Salter-Harris type IV fracture. The fracture line traverses the medial aspect of the lateral condylar ossification center.
  • Classification of medial condyle fractures in children is further subdivided based on the displacement of the fracture as described by Kilfoyle. Three fracture patterns have been described.
    • Kilfoyle type I is a nondisplaced fracture through the medial condylar metaphysis extending down to the physis. Type I fractures do not extend into the articular surface.
    • Kilfoyle type II fractures are also nondisplaced. The fracture line extends through the articular surface of the medial condylar physis.
    • Kilfoyle type III fractures involve displacement and rotation of the distal condylar fracture fragment.

Arthrography: On occasion, an elbow arthrogram may be used to help the physician clarify a fracture that is difficult to visualize because of an unossified condyle.

Ultrasonography and magnetic resonance imaging: These studies have also been used to further evaluate the unossified epiphysis in patients with traumatic elbow injuries.

Previous
Next

Procedures

Arthrocentesis

  • Distention of the elbow joint by an acute traumatic hemarthrosis is often painful; its presence may limit proper evaluation of the injured elbow. Therapeutic arthrocentesis to relieve a painful posttraumatic effusion is considered an acceptable practice. Diagnostically, arthrocentesis may help identify an occult fracture based on the presence of fat globules mixed with the aspirated blood.
  • Elbow arthrocentesis should be performed using an aseptic technique. The elbow is approached laterally through the radiohumeral joint. The elbow should be mostly extended, and the forearm should be held in a neutral position. The depression between the radial head and the lateral epicondyle of the humerus should be palpated. The needle is inserted just distal to the lateral epicondyle and is directed medially. Some authors recommend flexing the elbow to 90° and pronating the forearm prior to inserting the needle.
Previous
 
 
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.

Previous
Next
 
Milch classification of condylar fractures.
Medial epicondylar fracture
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.