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Clinical Practice Guidelines

Medial epicondyle fracture of the humerus - Fracture clinics

  • Fracture Guideline Index

    See also: Medial epicondyle fracture of the humerus - Emergency Department

    1. How often should these fractures be followed up in fracture clinics?
    2. What should I review at each appointment?
    3. What are the potential complications associated with this injury?
    4. When should I refer for an orthopaedic consultant opinion?
    5. What are the indications for discharge?

    1. How often should these fractures be followed up in fracture clinics?

    Table 1: Recommended follow-up schedule for medial epicondyle fractures of the humerus.

    Fracture type

    First appointment

    Subsequent review appointments

    Discharge advice to parents

    Closed treatment (non-operative)

    At 3 weeks post-injury with x-ray and removal of backslab

    Place in collar and cuff for 3 weeks and commence range of motion exercises

    At 9 weeks post-injury with x-ray

    Activity modification avoiding heavy arm use for one month after cast removal

    Physiotherapy is not recommended

    Operative treatment

    At 3 weeks post-operative with x-ray and removal of backslab

    Place in collar and cuff for 3 weeks and commence range of motion exercises.

    If concerned about wound, consider review at 1 week post-operative

    At 9 weeks post-operative with x-ray

    Consider listing for screw removal

    As above

    Medial condyle fracture

    At 1 week post-operative

    At 3 weeks post-operative with x-ray

    Place in collar and cuff for 3 weeks and commence range of motion exercises

    At 9 weeks post-operative with x-ray

    Consider whether longer term follow up is required. Watch for growth disturbance and avascular necrosis (AVN)

    As above
     

    		   

    2. What should I review at each appointment?

    Degree of displacement and acceptability of reduction. If displacement is >15 mm and has not had surgical reduction, consider whether operative intervention is required.

    3. What are the potential complications associated with this injury?

    • Nonunion medial epicondyle
    • Nonunion medial condyle
    • Ulnar nerve palsy
    • Elbow joint stiffness: usually more a feature of post-open reduction surgery

    4. When should I refer for an orthopaedic consultant opinion?

    Increasing separation and elbow instability.

    5. What are the indications for discharge?

    • Pain free range of motion 30-120 degrees elbow flexion
    • Non-tenderness at medial epicondyle
    • Joint stable to medial and lateral stress

    References (Outpatient setting)

    Beaty JH, Kasser JR. The elbow: Physeal fractures, apophyseal injuries of the distal humerus, avascular necrosis of the trochlea, and T-condylar fractures. In Rockwood and Wilkins' Fractures in Children, 7th Ed. Beaty JH, Kasser JR (Eds). Lippincott Williams & Wilkins, Philadelphia 2010. p.533-93.

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    Content developed by Victorian Paediatric Orthopaedic Network. 
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