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Partial Avulsion Patterns in the Pediatric Humeral Medial Epicondyle
Richard C Lee1,2, Akbar N Syed2, Margaret A Bowen2
1Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
Pediatric medial epicondyle fractures involve two distinct patterns: proximal ulnar collateral ligament (UCL) avulsion and cortical sleeve avulsion. Proximal UCL avulsion is more common, and understanding these patterns is key for treatment.
Area of Science:
- Orthopedic surgery
- Pediatric sports medicine
- Radiology
Background:
- The medial ulnar collateral ligament (UCL) and flexor pronator mass (FPM) have distinct anatomical footprints on the humeral medial epicondyle.
- Valgus stress can lead to focal injuries affecting these specific anatomical areas.
Purpose of the Study:
- To identify and characterize distinct injury patterns of the pediatric medial epicondyle.
- To differentiate between proximal UCL avulsion fractures and cortical sleeve avulsions.
Main Methods:
- Retrospective review of medial epicondyle fractures in patients under 18 years old from 2012-2022.
- Analysis of radiographic and MRI findings to classify fracture patterns and associated ligament/muscle attachments.
Main Results:
- 15.9% of medial epicondyle fractures showed fragmentation suggestive of partial avulsion.
- Proximal UCL avulsion fractures (n=78) were more common than cortical sleeve avulsions (n=35).
- MRI and operative reports confirmed UCL attachment in proximal avulsions and UCL/FPM attachment in cortical sleeve avulsions.
Conclusions:
- Two primary pediatric medial epicondyle injury patterns exist: proximal UCL avulsion and cortical sleeve avulsion.
- Accurate identification of these patterns is crucial for understanding prognosis and guiding treatment strategies.
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