Medial epicondyle avulsion fracture

Case contributed by Leonardo Lustosa

Presentation

Fall from standing height while playing football 3 weeks ago.

Patient Data

Age: 14 years
Gender: Male

Elbow radiographs revealed a displaced medial epicondyle, indicating a medial epicondyle avulsion fracture of the humerus.

See annotated image below.

Annotated image

Annotated image shows the medial epicondyle highlighted in red. The expected location of the medial epicondyle is shown by the white dotted line.

Case Discussion

Medial epicondylar fractures are usually associated with posterior elbow dislocations, which did not happen to this patient.

In the present case, the patient was initially treated non-operatively. On the follow-up examination, an unacceptable reduction of the medial epicondyle was observed and the patient was transferred to a tertiary referral trauma center for operative management.

The exact mechanism of trauma was unknown, but was assumed to be a fall onto the outstretched hand while playing football. The patient lost consciousness after the fall and could not recall the events in detail.

Of practical importance: it is important to be familiar with the elbow ossification centers when assessing a pediatric elbow. In this case, most ossification centers were already fused. Knowing the ossification centers, it is possible to recognize that the medial epicondyle ossification center is displaced distally by the traction of the medial collateral ligament.

 

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