Lateral epicondyle fracture (peds)

Background

• Salter-Harris type IV fracture
• Neurovascular injury uncommon

Humerus Fracture Types

Humeral anatomy

• Adult
  • Proximal
  • Shaft
  • Distal
    • Capitellum
    • Trochlea
    • Condylar
• Pediatric
  • Proximal
  • Shaft
  • Distal
    • Supracondylar
    • Lateral epicondyle
    • Medial epicondyle

Clinical Features

• Swelling and tenderness limited to lateral elbow
• neurovascular injury is uncommon

Differential Diagnosis

Elbow Diagnoses

Radiograph-Positive

• Distal humerus fracture
• Radial head fracture
  • Essex-Lopresti fracture
• Capitellum fracture
• Olecranon fracture
• Elbow dislocation

Radiograph-Negative

• Biceps tendon rupture/dislocation
• Lateral epicondylitis
• Medial epicondylitis
• Olecranon bursitis (nonseptic)
• Pronator teres syndrome
• Septic bursitis

Pediatric

• Nursemaid's elbow
• Supracondylar fracture
• Lateral epicondyle fracture
• Medial epicondyle fracture
• Olecranon fracture
• Radial head fracture
• Salter-Harris fractures

Evaluation

• Xray
  • Obtain oblique view if suspicion high despite neg AP/lat
  • Radiocapitellar line will not intersect middle of capitellum in all views
    • May be only sign of fracture if fracture is entirely through growth plate
  • +Fat Pad Sign/"sail" sign
    • May be only sign of nondisplaced fracture

Management

General Fracture Management

• Acute pain management
• Open fractures require immediate IV antibiotics and urgent surgical washout
• Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
• Consider risk for compartment syndrome

Specific Management

• Often requires ORIF (ortho consult)

See Also

• Elbow diagnoses