paediatric
Pediatric Medial Epicondyle Fracture
advanced
6 min
28 marks
6 questions
Clinical Scenario
A 12-year-old right-handed baseball pitcher presents after feeling a "pop" in his right elbow while throwing. He has immediate pain and swelling on the medial side of the elbow. He reports tingling in his small and ring fingers. On examination, there is marked tenderness over the medial epicondyle with swelling. Valgus stress produces pain. He has decreased sensation in the ulnar nerve distribution. Finger and wrist flexion strength is normal.
AP and lateral radiographs of a 12-year-old's right elbow demonstrating a displaced medial epicondyle fracture. The medial epicondyle ossification center is displaced inferiorly and medially by approximately 8mm. On the lateral view, the fragment appears to be at the level of the joint. This degree of displacement (>5mm) and the age of the patient suggest ORIF is indicated. The elbow is not dislocated. Ulnar nerve examination is essential.
Source: Displaced Medial Epicondyle Fractures in Children • PMC5293142 • CC-BY
Questions
Question 1 (4 marks)
Describe the imaging findings and how to diagnose this injury.
Question 2 (5 marks)
What is the mechanism and why is this injury associated with elbow dislocation?
Question 3 (6 marks)
What are the indications for surgery and describe the surgical technique?
Question 4 (5 marks)
How do you assess and manage ulnar nerve involvement?
Question 5 (4 marks)
What is "Little League Elbow" and how does it relate to this injury?
Question 6 (4 marks)
What are the outcomes and complications?
Exam Day Cheat Sheet
Must Mention
- •CRITOE: appears age 5
- •50% associated with elbow dislocation
- •Incarcerated fragment = surgical emergency
- •Ulnar nerve immediately posterior
- •Threshold controversial (>5mm traditional)
- •Little League Elbow = apophysitis
Common Pitfalls
- •Missing incarcerated fragment
- •Wrong CRITOE age
- •No ulnar nerve exam
- •Missing dislocation association
- •Wrong surgery threshold
- •Confusing with lateral condyle