Medial Condylar Fracture of the Elbow Treatment & Management

Updated: Oct 10, 2018
  • Author: John D Kelly, IV, MD; Chief Editor: Craig C Young, MD  more...
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Treatment

Acute Phase

Acute complications

Neurovascular complications can occur as a result of medial condylar fractures. One of the most feared acute vascular complications is the development of a compartment syndrome. As a result of bleeding and swelling in a closed fascial space, compartment pressures rise, circulation is compromised, and tissue hypoxia and ischemia can ensue.

The ulnar nerve enters the forearm as it passes behind the medial condyle. Fractures in this region place the ulnar nerve at considerable risk for injury.

Failure to make the proper diagnosis during the initial evaluation can complicate the management of these injuries. In young children, the proper diagnosis of a medial condyle fracture may be challenging. This is especially true in cases in which the trochlear epiphysis has not yet ossified. A delay in diagnosis often increases the likelihood of delayed healing or functional disability.

Early displacement of the fracture fragment can occur in fractures that are managed by closed-reduction methods.

Surgical intervention

The goal of treatment is to obtain proper reduction of the fracture fragment in order to restore alignment of the articular surface of the distal humerus. Fractures demonstrating 2 mm or more displacement generally require surgical fixation; closed reduction is difficult to achieve and maintain. Residual displacement is poorly tolerated. Some authors recommend anterior transposition of the ulnar nerve if the fracture involves the ulnar groove or if the nerve is injured.

Louahem et al investigated the effectiveness of surgical treatment for elbow instability in 139 children with displaced medial epicondylar fractures of the elbow. [3] In each patient, the medial epicondylar fragment was anatomically reduced and fixed; the mean follow-up period was 3.9 years. According to the authors, excellent results were achieved in 130 children and good results occurred in the remaining patients. Normal range of elbow motion reportedly returned in 133 children, and in all patients, union occurred and the treated elbows were pain free and stable. Louahem and colleagues concluded that surgical intervention is a good treatment strategy for medial epicondylar fractures. [4, 5]

Consultations

Refer patients with medial condylar fractures for evaluation by an orthopedist. Nondisplaced medial condylar fractures can be splinted during the patient's initial emergency department evaluation in a long arm posterior splint; refer the patient for outpatient follow-up in 2-3 days. Displaced fractures require more urgent referral to an orthopedist for surgical fixation.

Other Treatment

Long arm posterior splint

  • A type I injury with a nondisplaced fracture fragment is often initially treated with either a long arm posterior splint or a long arm cast, followed by referral to an orthopedist.

  • Patients with medial condylar fractures are splinted with the affected elbow flexed, the forearm pronated, and the wrist held in a flexed position. The reason for this positioning is to help relieve the tension on the forearm flexor muscle attachments. The long arm posterior splint prevents flexion and extension of the injured elbow.

  • Follow-up radiographs are taken within 5-7 days and weekly thereafter 3 times to ensure that delayed displacement of the fracture fragment is not present.

  • Immobilization is recommended for 4-6 weeks, followed by range-of-motion exercises.

A double sugar-tong splint

  • A double sugar-tong splint is an alternative to the long arm posterior splint.

  • In addition to preventing flexion and extension, the double sugar-tong splint prevents pronation and supination of the forearm.

  • This may be preferred for more complex or displaced fractures of the elbow.

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Recovery Phase

Rehabilitation Program

Physical Therapy

Barring any other traumatic injury, the patient should maintain general fitness during the rehabilitation phase of treatment, if possible. After the initial period of immobilization, initiate active assisted range-of-motion exercises. Forceful manipulation of the joint should be avoided in order to lessen the occurrence of heterotopic calcification. Implement progressive resistance training once motion is restored, with the goal of reaching preinjury strength and flexibility.

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