The medial epicondyle fracture is an avulsion fracture of the apophysis and often accompanies elbow dislocation. Closed reduction of the medial epicondyle is most successful if done at the time of reduction of the elbow dislocation itself.
If the medial epicondylar fragment is trapped in the joint, open reduction is often necessary, although the following closed reduction maneuver can be attempted.
The main soft tissue attachments of the medial epicondyle are the flexor-pronator muscles of the forearm. These remain attached to the fragment and can be used to aid closed reduction.
Percutaneous fixation is not recommended due to vulnerability of the ulnar nerve.
2. Patient preparation
This procedure is normally performed with the patient in a supine position.
When the child is discharged from the hospital, the parent/caregiver should be taught how to assess the limb.
They should also be advised to return if there is increased pain or decreased range of finger motion.
It is important to provide parents with the following additional information:
The warning signs of compartment syndrome, circulatory problems and neurological deterioration
Hospital telephone number
For the first few days, the elbow and forearm can be elevated on a pillow, until swelling decreases and comfort returns.
When the limb is comfortable, the child may optionally use a sling to support any splint if desired. Many children are more comfortable without a sling.
Control x-rays may be taken at one week following injury to assess fracture position and then at three weeks, out of any splintage, to assess fracture healing.
Removal of cast or splint
Fractures treated by closed reduction with splints, or casts, and fractures treated with closed reduction and percutaneous pinning should have the splintage removed 3 weeks after the injury date.
Protruding K-wires can be removed in the clinic, without anesthesia.
A simple sling can be provided for comfort.
Recovery of motion
As symptoms recover, the child should be encouraged to remove the sling and begin active movements of the elbow.
The majority of elbow motion is recovered rapidly within the two months after the splint is removed. The older child may take a little longer.
Once the child is comfortable, with a nearly complete range of motion, he/she may resume noncontact sports incrementally. Resumption of unrestricted physical activity is a matter for judgment by the treating surgeon.