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synonyms: pediatric elbow fracture
Medial Epicondyle Fracture ICD-10
A- initial encounter for closed fracture
B- initial encounter for open fracture
D- subsequent encounter for fracture with routine healing
G- subsequent encounter for fracture with delayed healing
K- subsequent encounter for fracture with nonunion
P- subsequent encounter for fracture with malunion
S- sequela
Medial Epicondyle Fracture ICD-9
- 812.43(closed)
- 812.53(open)
Medial Epicondyle Fracture Etiology / Epidemiology / Natural History
- 11% of peds elbow fxs
- most common ages =9-14yrs
Medial Epicondyle Fracture Anatomy
- Valgus force to the elbow typically causing avulsion of the flexor prohator origin and meidal collateral ligament.
Medial Epicondyle Fracture Clinical Evaluation
- Medial elbow pain and swelling
- Instability to valgus stress.
- Document NV exam before and after any treatment.
Medial Epicondyle Fracture Xray / Diagnositc Tests
Medial Epicondyle Fracture Classification / Treatment
- nonsurgical treatment even for widely displaced fxs. Posterior mold initially, LAC for <3wks. Begin AROM asap-7-10 days depending on fx. Nonsurgical management usually results in a painless nonunion with good elbow function and little elbow instability. Prolonged immobilization should be avoided to prevent stiffness
- 35 yr follow-up displaced (mean 6mm) treated with immobilization showed very good function and ROM, with 55% pseudoarthrosis. Symptoms did not differ between groups c or s pseudoarthrosis. (Josefsson PO, Acta Orthop Scand 57:313:1986)
- surgery = increased radiographic union, but more minor symptoms than conservative treatment
- Surgery indicated for irreducible incarceration of the medial epicondyle within the joint, suspected ulnar nerve entrapment, open fracture, fractures in throwing athletes with valgus instability.
- Relative indications=children likely place excessive valgus stress on elbow such as gymnast or pitcher(Case SL, Am J Sports Med 25:682;1997)
- fragment excision is associated with poor outcomes in adulthood (Farsetti JBJS83A:1299;2001)
Medial Epicondyle Fracture Associated Injuries / Differential Diagnosis
- up to 50% may be associated with elbow dislocation
Medial Epicondyle Fracture Complications
Medial Epicondyle Fracture Follow-up Care
Medial Epicondyle Fracture Review References
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