Epicondylar and transphyseal elbow fractures in children
- Leticia Manning Ryan, MD, MPH, FAAP
Leticia Manning Ryan, MD, MPH, FAAP
- Assistant Professor of Pediatrics
- Division of Emergency Medicine
- Johns Hopkins Children's Center
- Section Editor
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Epicondylar elbow fractures most commonly occur in older boys after a fall on an outstretched arm [1-3]. Medial epicondylar fractures comprise 10 percent of all elbow fractures in children. Many of these fractures may be managed with splinting and early active motion. However, surgery is required in children with open fractures, bony fragments that are incarcerated in the elbow joint, or complete ulnar nerve deficit. Lateral epicondylar fractures are rare and do not require surgical intervention [3,4].
Transphyseal fractures are relatively uncommon fractures seen in infants and young children. They are associated with child abuse and birth trauma. Proper orthopedic treatment typically requires closed reduction with percutaneous pinning. Diagnosis of a transphyseal elbow fracture in a child with no plausible mechanism of injury should prompt involvement of an experienced child protection team (eg, social worker, nurse, physician with more extensive experience in the management of child abuse), if available, and reporting of suspected child abuse to proper authorities, as required.
This topic review addresses epicondylar and transphyseal elbow fractures in children. Supracondylar and condylar elbow fractures are discussed separately. (See "Evaluation and management of supracondylar fractures in children" and "Evaluation and management of condylar elbow fractures in children".)
Medial epicondylar fractures comprise approximately 10 percent of elbow fractures in children . These fractures are much more common in boys than girls. Age of occurrence ranges from 9 to 14 years. Falls account for most of these fractures . Case reports also describe medial epicondylar fractures occurring after throwing a baseball and arm wrestling in boys [5,6]. Fifty percent of medial epicondyle fractures are associated with a posterior elbow dislocation, so elbow stability must be evaluated [7,8].
Fractures of the lateral epicondyle are unusual and typically arise from a fall on an outstretched hand or a direct blow .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Della-Giustina K, Della-Giustina DA. Emergency department evaluation and treatment of pediatric orthopedic injuries. Emerg Med Clin North Am 1999; 17:895.
- Carson S, Woolridge DP, Colletti J, Kilgore K. Pediatric upper extremity injuries. Pediatr Clin North Am 2006; 53:41.
- Gogola GR. Pediatric humeral condyle fractures. Hand Clin 2006; 22:77.
- Bachman D, Santora S. Orthopedic trauma. In: Textbook of Pediatric Emergency Medicine, 5th ed, Fleisher GR, Ludwig S (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.1538.
- Beaty JH, Kasser JR. The elbow: physeal fractuers, apophyseal injuries of the distal humerus, osteonecrosis of the trochlea, and T-condylar fractures. In: Rockwood and Wilkins' Fractures in Children, 5th, Beaty JH, Kasser JR (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.628.
- Nyska M, Peiser J, Lukiec F, et al. Avulsion fracture of the medial epicondyle caused by arm wrestling. Am J Sports Med 1992; 20:347.
- Neviaser JS, Wickstrom JK. Dislocation of the elbow: a retrospective study of 115 patients. South Med J 1977; 70:172.
- Fowles JV, Slimane N, Kassab MT. Elbow dislocation with avulsion of the medial humeral epicondyle. J Bone Joint Surg Br 1990; 72:102.
- Silberstein MJ, Brodeur AE, Graviss ER. Some vagaries of the lateral epicondyle. J Bone Joint Surg Am 1982; 64:444.
- DeLee JC, Wilkins KE, Rogers LF, Rockwood CA. Fracture-separation of the distal humeral epiphysis. J Bone Joint Surg Am 1980; 62:46.
- Akbarnia BA, Silberstein MJ, Rende RJ, et al. Arthrography in the diagnosis of fractures of the distal end of the humerus in infants. J Bone Joint Surg Am 1986; 68:599.
- Siffert, RS. Displacement of distal humeral epiphysis in newborn infant. J Bone Joint Surg Am 1963; 45:165.
- Barrett WP, Almquist EA, Staheli LT. Fracture separation of the distal humeral physis in the newborn. J Pediatr Orthop 1984; 4:617.
- Dameron TB Jr. Transverse fractures of distal humerus in children. Instr Course Lect 1981; 30:224.
- Shrader MW. Pediatric supracondylar fractures and pediatric physeal elbow fractures. Orthop Clin North Am 2008; 39:163.
- Smith FM. Children's elbow injuries: fractures and dislocations. Clin Orthop Relat Res 1967; 50:7.
- Josefsson PO, Danielsson LG. Epicondylar elbow fracture in children. 35-year follow-up of 56 unreduced cases. Acta Orthop Scand 1986; 57:313.
- Green NE. Fractures and dislocations about the elbow. In: Skeletal Trauma in Children, 3rd ed, Green NE, Swiontkowski MF (Eds), WB Saunders, Philadelphia 2003. p.257.
- Price C, Phillips J, Devito D. Management of fractures. In: Lovell & Winter's Pediatric Orthopaedics, 5th, Morrissey, Weinstein SL (Eds), Lippincott Williams & Wilkins, Philadelphia 2001. p.1319.
- Baratz M, Micucci C, Sangimino M. Pediatric supracondylar humerus fractures. Hand Clin 2006; 22:69.
- Keppler P, Salem K, Schwarting B, Kinzl L. The effectiveness of physiotherapy after operative treatment of supracondylar humeral fractures in children. J Pediatr Orthop 2005; 25:314.
- Campbell CC, Waters PM, Emans JB, et al. Neurovascular injury and displacement in type III supracondylar humerus fractures. J Pediatr Orthop 1995; 15:47.
- Farsetti P, Potenza V, Caterini R, Ippolito E. Long-term results of treatment of fractures of the medial humeral epicondyle in children. J Bone Joint Surg Am 2001; 83-A:1299.
- Abe M, Ishizu T, Nagaoka T, Onomura T. Epiphyseal separation of the distal end of the humeral epiphysis: a follow-up note. J Pediatr Orthop 1995; 15:426.
- PERTINENT ANATOMY
- MECHANISM OF INJURY
- Epicondylar fracture
- Distal transphyseal fractures
- PHYSICAL FINDINGS
- RADIOGRAPHIC FINDINGS
- Epicondylar fractures
- Transphyseal fractures
- INITIAL TREATMENT
- Orthopedic consultation
- Child protection
- DEFINITIVE CARE
- Medial epicondylar fractures
- Lateral epicondylar fractures
- Transphyseal fracture
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Epicondylar fractures
- Distal humeral transphyseal fractures