Overview
Fracture of the medial humeral epicondyle typically involves the bony prominence near the elbow, often resulting from valgus stress, commonly seen in athletes and sports-related injuries. 2Diagnosis
Clinical presentation includes pain, swelling, and limited range of motion around the elbow.
Radiographic imaging (X-rays) is essential for confirming the fracture and assessing displacement.
MRI may be considered for detailed soft tissue evaluation, particularly in cases of suspected radial nerve involvement. 2Management
Non-operative treatment: Functional bracing is commonly used, aiming to immobilize the elbow while allowing early mobilization of the shoulder and wrist. 1
Operative treatment: Intramedullary nailing (IMN) or plate osteosynthesis may be indicated for displaced fractures or those with significant instability. 1
Radial nerve assessment: Regular neurological evaluations are crucial, especially in operatively managed cases due to higher risk of secondary radial nerve palsies. 12Special Populations
Pediatrics: Specific considerations for growth plate involvement may necessitate different treatment approaches, though detailed evidence from provided abstracts is limited. 1
Elderly: Increased risk of complications and slower healing may influence the choice towards non-operative management unless instability dictates surgery. 1Key Recommendations
For non-displaced medial humeral epicondyle fractures, non-operative treatment with functional bracing is recommended to achieve satisfactory healing outcomes. (Evidence: Moderate 1)
Operative intervention, such as IMN or plate osteosynthesis, should be considered for displaced fractures to optimize stability and alignment, despite a higher risk of secondary radial nerve palsy. (Evidence: Moderate 12)
Regular neurological monitoring is essential in operatively treated patients due to increased risk of radial nerve complications. (Evidence: Moderate 12)References
1 Van Bergen SH, Mahabier KC, Van Lieshout EMM, Van der Torre T, Notenboom CAW, Jawahier PA et al.. Humeral shaft fracture: systematic review of non-operative and operative treatment. Archives of orthopaedic and trauma surgery 2023. link
2 Hak DJ. Radial nerve palsy associated with humeral shaft fractures. Orthopedics 2009. link