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Fractures of the medial humeral epicondyle in children
Insights
This review of medial humeral epicondyle fractures in children suggests sling-only treatment for isolated injuries yields good outcomes. Associated dislocations may require different management strategies for optimal results.
Area of Science:
- Pediatric Orthopedics
- Traumatology
- Skeletal Biology
Background:
- Medial humeral epicondyle fractures are uncommon in children.
- These fractures are often associated with elbow dislocations, sometimes with spontaneous reduction.
- A clear classification and management strategy is needed.
Purpose of the Study:
- To classify medial humeral epicondyle fractures in children.
- To evaluate management strategies and outcomes for these fractures.
- To recommend optimal treatment based on injury type.
Main Methods:
- Retrospective review of 50 pediatric cases with medial humeral epicondyle fractures.
- Classification of injury based on association with elbow dislocation.
- Analysis of treatment outcomes (sling only, open treatment, closed treatment).
Main Results:
- "Apparent isolated" medial humeral epicondyle fractures treated with a sling alone showed 90% good results.
- Poorer outcomes were observed with open treatment or when fractures were associated with dislocation.
- Indications for open reduction include ulnar neuritis or intra-articular fragments.
Conclusions:
- Closed treatment, particularly with a sling for isolated injuries, is recommended for pediatric medial humeral epicondyle fractures.
- Open reduction should be reserved for specific complex cases.
- Accurate classification aids in guiding appropriate management.
Abstract:
A review of 50 children with fractures of the medial humeral epicondyle facilitated a simple classification of this injury and its management. The "apparent isolated" fracture of the medial humeral epicondyle is uncommon; it is more frequently associated with elbow dislocation, with or without spontaneous reduction, at the time of injury. Analysis of the results of treatment of medial humeral epicondylar fractures in this group of children showed that, in the case of those with an "apparent isolated" injury, treatment with a sling only gave good results in 90% whereas poorer results followed open treatment or fractures associated with dislocation. Closed treatment is therefore recommended. Open reduction is indicated only with (a) ulnar neuritis at the time of injury or (b) intra-articular fragment.