Unicondylar fractures of the distal femur sciencedirect. They are typically seen in children, and can be challenging to identify. Lateral condyle and medial epicondyle fractures in children. Impaction fracture of the medial femoral condyle journal. A fracture in this projection is called a medial epicondyle fracture of the humerus and is different from a humerus shaft fracture. Epicondyle fractures are common injuries in children. Fractures of the medial epicondyle represent 11 to 20% of elbow fractures. At the lateral condyle, the fracture line radiates either in the coronal plane, detaching the most posterior part of the condyle hoffa fracture or ao33 b3 b3 type. The medial epicondyle physis of the distal humerus is a posterior structure angled distally and posteriorly. Separation of the epiphysis of the medial internal epicondyle epitrochlea of the humerus is, as the name implies, an injury of childhood or adolescence. This is done either with manual traction or if neces. The main difference between condyle and epicondyle is that condyle forms an articulation with another bone. With the intention of a speedy return to baseball and normal function, the patient and his family opted for open reduction. Head neck greater trochanter lesser trochanter intertrochanteric crest intertrochanteric line gluteal.
In all patients with a medial epicondyle fracture, it is essential to test for medial elbow stability schwab et al. There is fracture avulsion of the internal medial epicondyle ossification center which is absent from its normal position. Multiple fixation techniques have been advocated for fixation for articular fractures of the distal femur. Include any exams preformed under anesthesia positioning describe and provide or photos to illustrate p. Our elbow is a joint where the arm bone humerus meets up with your two forearm bones the radius and the ulna. Fracture of the lateral femoral condyle journal of. Directly below it is a small depression from which a smooth wellmarked groove curves obliquely upward and backward to. Epidemiologically speaking, they account for nearly 12% of all elbow fractures and are, therefore, not uncommon injuries. This lesson explains what an epicondyle is, what a fracture is, and how a. Lateral epicondylerounded projection of the bone prior to the condyle which serves as a. The fundamental principles of fracture care apply to medial epicondyle fractures in that the goals of treatment are to obtain fracture healing and to promote a return of appropriate motion. It is displaced inferiorly and located just medial to the coronoid. The typical mechanism is a fall onto an outstretched hand, creating a valgus load at the elbow leading to avulsion of the epicondyle from pull of either the flexorpronator mass or ulnar collateral ligament. Treatment of medial epicondyle fracture without associated.
While this fracture is rare in adults, it is more common in children, along with pediatric wrist and hand fractures. A case report pierre lafforgue and pierreclaude acquaviva an 88yearold woman complained of pain in the medial part of her knee for 5 weeks. Operative fixation of medial humeral epicondyle fracture. Clinical and scintigraphic findings were suggestive of spontaneous osteonecrosis of the medial femoral condyle.
Intertrochanteric means between the trochanters, which are bony protrusions on the femur thighbone. Medial epicondyle fractures of the humerus request pdf. The lateral epicondyle of the femur, smaller and less prominent than the medial epicondyle, gives attachment to the fibular collateral ligament of the kneejoint. A fracture of distal femur often involves the physis and may lead to growth.
Operative versus nonoperative management of pediatric. Medial epicondyle fracture radiology reference article. Medial epicondyle fractures, elbow dislocations, and. The tibial shaft fracture was fixed with an intra medullary nail.
Its occurrence is more frequent than is usually supposed. Fifty percent of medial epicondyle fractures are associated with an elbow dislocation. Dynamic condylar screws, lag screw fixation as well as. Outcome was assessed with radiographs and a questionnaire that included 3 selfreported functional outcome tools at a mean of 4. Indications discuss indications and more general concerns. We present a case of large osteochondral fracture of lateral femoral condyle involving the articular surface in a fifteenyearold male with a positive history of significant weight gain of 5 kilograms in last six months.
Medial condyle fractures are intraarticular, extending into the elbow joint and require urgent open reduction internal fixation orif. They are usually caused by direct trauma or twisting injuries of the knee. Medial humeral epicondyle fractures are relatively common in older children and adolescents, and are associated with elbow dislocation in 3050% of cases. By definition, the fracture line must involve the trochlear articular surface. Osteochondral fracture lateral femoral condyle treated. Medial epicondyle fractures comprise most of these injuries. How to walk correctly and fix your lower back pain. Fractures of the medial epicondyle are a common pediatric injury, representing 12% to 20% of all pediatric elbow fractures 1, 2, 3.
Methods eight patients with symptomatic medial humeral epicondyle nonunions were evaluated after open reduction and internal fixation of the medial epicondyle. Abstract traditional management by cast immobilization increasingly is being replaced with early fixation and mobilization. Pdf operative management of hoffa fracture of the femoral condyle. They can usually be treated with splinting and early physiotherapy. In 1883, stimson first described the fracture patterns in lateral condyle fractures in his book treatise on fractures. They represent 10% of all elbow fractures in children and usually occur in boys after a fall on an outstretched arm. Isolated fractures can occur secondary to direct trauma or avulsion forces. He described the fracture as beginning in the lateral metaphysis proximal to the condyle, coursing distally, and exiting through the articular surface through the medial trochlear notch or through the capitellotrochlear groove. Open vertical sagittal fracture patella with fracture lateral condyle. Located at the distal end of the femur posterior of the femur 1 medial condyle of the femur. Broken elbow medial epicondyle fracture bone talks.
An intertrochanteric fracture is a specific type of hip fracture. Indeed, nonoperative management of medial humeral epicondyle fracture is an interesting issue for discussion. Stress fracture of the lateral femoral condyle after total knee. Medial epicondyle fractures demographic 20% of elbow fractures 60% of which are associated with elbow dislocation. Medial condyle fractures involve a fracture line that extends through and separates the medial metaphysis and epicondyle from the rest of the humerus see image below. Lateral epicondylar femoral avulsion fracture combined. Ta the epicondylus located proximal to the medial condyle.
Medial epicondyle fractures the hospital for sick children. A medial epicondyle fracture is a type of broken elbow seen in kids. Medial epicondyle fractures represent almost all epicondyle fractures and occur when there is avulsion of the medial epicondyle. To understand why, we need to first talk about how bones develop in kids. The surgical treatments are considered when the fracture fragment is displaced into the elbow joint, when ulnar nerve. A subsection of these injuries need operative intervention. A lateral condyle fracture is regarded among doctors as a fracture that is difficult to diagnose and therefore is often missed. Humeral medial epicondyle fracture management in the pediatric population continues to remain a topic of debate. Treatment of medial epicondyle fractures accompanying elbow dislocations in children article pdf available in acta orthopaedica et traumatologica turcica 394. Medial condyle fractures are intraarticular, extending into the elbow joint and require urgent open reduction and internal fixation orif. Stress testing may be difficult secondary to pain and is generally not recommended in the alert child, but can be performed under sedation if. Fixedangle implants are often used for fixation of distal femur fractures. Because the patient was unable to bear weight on his right lower extremity or flex his right knee to 90, the physical therapist ordered radiographs of the right knee, 2 which demonstrated a fracture of the lateral femoral condyle posteriorly. Hoffa fractures are coronalplane fractures of the femoral condyle, which are rarer than sagittalplane condylar fractures.
The patient was a 20yearold man who sustained a noncontact left knee hyperextension injury while playing soccer. Nondisplaced fracture avulsion of lateral epicondyle of left humerus, subsequent encounter for fracture with routine healing. Medial epicondyle fractures of the humerus account for 1220% of pediatric elbow fractures. A new procedure for fractures of the medial epicondyle in. Kids broken elbow lateral condyle fracture bone talks. The supracondylar region distal metaphysis flares medially greater. I am coding a radiology report written by our ed physician that says, posterior dislocation of the radial ulnar unit with respect to the distal humerus, associated with a joint effusion and avulsions of the lateral epicondyle and ulnar coronoid process. A pediatric medial epicondyle fracture cadaveric study. The disadvantage of these two methods of fixation is that the. One of the two large rounded articular masses of the distal end of the femur, united anteriorly with its contralateral partner by the patellar surface but separated from it posteriorly and inferiorly by the intercondylar fossa.
Radiographs revealed an avulsion fracture of the lateral epicondyle of the femur and a fracture of the tibial shaft. Medial epicondyle fracture of the humerus ed smith. An mri scan showed the lateral epicondyle was avulsed by the lcl and the popliteus tendon. It is a specialized part of some of the bones found in the human body. Distal femur fracture orif with single lateral plate orthobullets team trauma. Osteochondral fractures of lateral femoral condyle are common in adolescents and young adults. A novel technique for fixation of a medial femoral condyle. Three commonly used implants implants a, b and c are shown in figures a, b and c respectively. Failure to diagnose these injuries can lead to significant long term disability. Short video describing the skeletal structures of the femur structural markings identified. It is important to distinguish a medial epicondyle fracture common from a medial condyle fracture very rare. Interestingly, rosendahl9 reported an 8 year followup of a displaced intraarticular medial epicondyle fracture in which there was only minor loss of elbow motion with little functional disability.
Pdf hoffa fracture is a rare injury consisting of unicondylar tangential posterior fracture of the distal femur and only very few cases have been. Stress fracture of the distal femur fractures above the femoral component is an uncommon but one of the challenging complications that may. When displacement was 5 mm, the distal humerus axial radiograph technique was significantly more accurate than the ap radiograph technique at determining actual fracture displacement in our adult cadaveric fracture models. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Nonsurgical management with a plaster cast has been used for many years but nonunion and thus valgus instability has been observed in 60% of cases, so that at present surgeons prefer surgical treatment with wire or screw fixation.
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