Medial epicondyle fractures of the humerus account for 1220% of pediatric elbow fractures. Lateral epicondylar femoral avulsion fracture combined. An intertrochanteric fracture is a specific type of hip fracture. Include any exams preformed under anesthesia positioning describe and provide or photos to illustrate p. Hoffa fractures are coronalplane fractures of the femoral condyle, which are rarer than sagittalplane condylar fractures. A new procedure for fractures of the medial epicondyle in.
Indications discuss indications and more general concerns. They represent 10% of all elbow fractures in children and usually occur in boys after a fall on an outstretched arm. Radiographs revealed an avulsion fracture of the lateral epicondyle of the femur and a fracture of the tibial shaft. Impaction fracture of the medial femoral condyle journal. Treatment of medial epicondyle fracture without associated. Medial epicondyle fractures demographic 20% of elbow fractures 60% of which are associated with elbow dislocation. The supracondylar region distal metaphysis flares medially greater. Stress fracture of the distal femur fractures above the femoral component is an uncommon but one of the challenging complications that may. They can usually be treated with splinting and early physiotherapy. Methods eight patients with symptomatic medial humeral epicondyle nonunions were evaluated after open reduction and internal fixation of the medial epicondyle.
Osteochondral fracture lateral femoral condyle treated. Interestingly, rosendahl9 reported an 8 year followup of a displaced intraarticular medial epicondyle fracture in which there was only minor loss of elbow motion with little functional disability. While this fracture is rare in adults, it is more common in children, along with pediatric wrist and hand fractures. Outcome was assessed with radiographs and a questionnaire that included 3 selfreported functional outcome tools at a mean of 4. Lateral epicondylerounded projection of the bone prior to the condyle which serves as a. It is a specialized part of some of the bones found in the human body. Osteochondral fractures of lateral femoral condyle are common in adolescents and young adults. Nondisplaced fracture avulsion of lateral epicondyle of left humerus, subsequent encounter for fracture with routine healing. By definition, the fracture line must involve the trochlear articular surface. Its occurrence is more frequent than is usually supposed. The surgical treatments are considered when the fracture fragment is displaced into the elbow joint, when ulnar nerve. There is fracture avulsion of the internal medial epicondyle ossification center which is absent from its normal position. Pdf hoffa fracture is a rare injury consisting of unicondylar tangential posterior fracture of the distal femur and only very few cases have been.
Medial epicondyle fractures represent almost all epicondyle fractures and occur when there is avulsion of the medial epicondyle. Medial epicondyle fractures comprise most of these injuries. Intertrochanteric means between the trochanters, which are bony protrusions on the femur thighbone. To understand why, we need to first talk about how bones develop in kids. Epidemiologically speaking, they account for nearly 12% of all elbow fractures and are, therefore, not uncommon injuries. A novel technique for fixation of a medial femoral condyle. It is important to distinguish a medial epicondyle fracture common from a medial condyle fracture very rare. Indeed, nonoperative management of medial humeral epicondyle fracture is an interesting issue for discussion.
Pdf operative management of hoffa fracture of the femoral condyle. Distal femur fracture orif with single lateral plate orthobullets team trauma. In all patients with a medial epicondyle fracture, it is essential to test for medial elbow stability schwab et al. With the intention of a speedy return to baseball and normal function, the patient and his family opted for open reduction. A pediatric medial epicondyle fracture cadaveric study. When displacement was 5 mm, the distal humerus axial radiograph technique was significantly more accurate than the ap radiograph technique at determining actual fracture displacement in our adult cadaveric fracture models. It is displaced inferiorly and located just medial to the coronoid. They are usually caused by direct trauma or twisting injuries of the knee. The tibial shaft fracture was fixed with an intra medullary nail.
Medial condyle fractures involve a fracture line that extends through and separates the medial metaphysis and epicondyle from the rest of the humerus see image below. A subsection of these injuries need operative intervention. Unicondylar fractures of the distal femur sciencedirect. Because the patient was unable to bear weight on his right lower extremity or flex his right knee to 90, the physical therapist ordered radiographs of the right knee, 2 which demonstrated a fracture of the lateral femoral condyle posteriorly. Separation of the epiphysis of the medial internal epicondyle epitrochlea of the humerus is, as the name implies, an injury of childhood or adolescence.
Our elbow is a joint where the arm bone humerus meets up with your two forearm bones the radius and the ulna. The main difference between condyle and epicondyle is that condyle forms an articulation with another bone. The patient was a 20yearold man who sustained a noncontact left knee hyperextension injury while playing soccer. The typical mechanism is a fall onto an outstretched hand, creating a valgus load at the elbow leading to avulsion of the epicondyle from pull of either the flexorpronator mass or ulnar collateral ligament.
A medial epicondyle fracture is a type of broken elbow seen in kids. He described the fracture as beginning in the lateral metaphysis proximal to the condyle, coursing distally, and exiting through the articular surface through the medial trochlear notch or through the capitellotrochlear groove. Three commonly used implants implants a, b and c are shown in figures a, b and c respectively. Fractures of the medial epicondyle are a common pediatric injury, representing 12% to 20% of all pediatric elbow fractures 1, 2, 3. The fundamental principles of fracture care apply to medial epicondyle fractures in that the goals of treatment are to obtain fracture healing and to promote a return of appropriate motion. I am coding a radiology report written by our ed physician that says, posterior dislocation of the radial ulnar unit with respect to the distal humerus, associated with a joint effusion and avulsions of the lateral epicondyle and ulnar coronoid process. Dynamic condylar screws, lag screw fixation as well as. Operative versus nonoperative management of pediatric. A fracture of distal femur often involves the physis and may lead to growth. Medial epicondyle fracture radiology reference article. Failure to diagnose these injuries can lead to significant long term disability.
Abstract traditional management by cast immobilization increasingly is being replaced with early fixation and mobilization. Located at the distal end of the femur posterior of the femur 1 medial condyle of the femur. This lesson explains what an epicondyle is, what a fracture is, and how a. Medial condyle fractures are intraarticular, extending into the elbow joint and require urgent open reduction and internal fixation orif. Fixedangle implants are often used for fixation of distal femur fractures. Isolated fractures can occur secondary to direct trauma or avulsion forces. Medial epicondyle fractures, elbow dislocations, and. Medial epicondyle fractures the hospital for sick children. Ta the epicondylus located proximal to the medial condyle. Medial epicondyle fractures of the humerus request pdf.
A case report pierre lafforgue and pierreclaude acquaviva an 88yearold woman complained of pain in the medial part of her knee for 5 weeks. The disadvantage of these two methods of fixation is that the. Treatment of medial epicondyle fractures accompanying elbow dislocations in children article pdf available in acta orthopaedica et traumatologica turcica 394. The medial epicondyle physis of the distal humerus is a posterior structure angled distally and posteriorly. Epicondyle fractures are common injuries in children. Directly below it is a small depression from which a smooth wellmarked groove curves obliquely upward and backward to. The lateral epicondyle of the femur, smaller and less prominent than the medial epicondyle, gives attachment to the fibular collateral ligament of the kneejoint. Short video describing the skeletal structures of the femur structural markings identified. Clinical and scintigraphic findings were suggestive of spontaneous osteonecrosis of the medial femoral condyle.
Medial epicondyle fracture of the humerus ed smith. One of the two large rounded articular masses of the distal end of the femur, united anteriorly with its contralateral partner by the patellar surface but separated from it posteriorly and inferiorly by the intercondylar fossa. This is done either with manual traction or if neces. Open vertical sagittal fracture patella with fracture lateral condyle. Nonsurgical management with a plaster cast has been used for many years but nonunion and thus valgus instability has been observed in 60% of cases, so that at present surgeons prefer surgical treatment with wire or screw fixation. Fractures of the medial epicondyle represent 11 to 20% of elbow fractures.
They are typically seen in children, and can be challenging to identify. Stress testing may be difficult secondary to pain and is generally not recommended in the alert child, but can be performed under sedation if. Medial condyle of femur definition of medial condyle of. Broken elbow medial epicondyle fracture bone talks. Learn vocabulary, terms, and more with flashcards, games, and other study tools. An mri scan showed the lateral epicondyle was avulsed by the lcl and the popliteus tendon. Multiple fixation techniques have been advocated for fixation for articular fractures of the distal femur.
Fifty percent of medial epicondyle fractures are associated with an elbow dislocation. Humeral medial epicondyle fracture management in the pediatric population continues to remain a topic of debate. Fracture of the lateral femoral condyle journal of. We present a case of large osteochondral fracture of lateral femoral condyle involving the articular surface in a fifteenyearold male with a positive history of significant weight gain of 5 kilograms in last six months. A fracture in this projection is called a medial epicondyle fracture of the humerus and is different from a humerus shaft fracture. How to walk correctly and fix your lower back pain. Operative fixation of medial humeral epicondyle fracture. Head neck greater trochanter lesser trochanter intertrochanteric crest intertrochanteric line gluteal. A lateral condyle fracture is regarded among doctors as a fracture that is difficult to diagnose and therefore is often missed. Medial condyle fractures are intraarticular, extending into the elbow joint and require urgent open reduction internal fixation orif. In 1883, stimson first described the fracture patterns in lateral condyle fractures in his book treatise on fractures. Medial humeral epicondyle fractures are relatively common in older children and adolescents, and are associated with elbow dislocation in 3050% of cases.
222 755 231 1448 403 1206 865 1065 539 805 188 699 980 729 1195 416 1347 1000 451 87 146 1039 229 922 180 805 878 71 1247 135 29 825 1264 190 148 49 332 424 1179 1359 10 506 1159 216 891 761 941 962