How Displaced Are "Nondisplaced" Fractures of the Medial Humeral Epicondyle in Children? Results of a Three-Dimensional Computed Tomography Analysis

Edmonds, Eric W.
December 2010
Journal of Bone & Joint Surgery, American Volume;12/1/2010, Vol. 92-A Issue 17, p2785
Academic Journal
Background: The management of fractures of the medial humeral epicondyle is controversial, but the primary issue is the relationship of outcomes to the extent of fracture displacement. This study compares the use of radiographs and three-dimensional computed tomography for determining the amount of displacement in medial humeral epicondylar injuries deemed to be minimally displaced (<5 mm) or nondisplaced. Methods: A retrospective review was performed on the cases of all patients with a fracture of the medial humeral epicondyle that had been diagnosed as minimally displaced or nondisplaced who were seen over a one-year period at our institution. Measurements of medial and anterior displacement on both the radiographs and three-dimensional computed tomography scan were recorded. Measurements of displacement were also recorded on internal oblique radiographs of the elbow, if available. Demographics, treatment, and any additional findings by computed tomography scans were noted. Means and Student t tests were utilized for statistical analysis. Results: The eleven patients who met the inclusion criteria had a mean age of 12.2 years (range, 7.3 to 15.4 years). One fracture that involved the medial condyle on the computed tomography scan was excluded from the analysis. Anterior displacement was immeasurable on all but one lateral radiograph and recorded as 0 mm; the mean was 0.9 mm, which was significantly less than the anterior displacement on the three-dimensional computed tomography scan (mean, 8.8 mm; range, 0 to 15 mm) (p ≤ 0.001). Conversely, mean medial displacement on anteroposterior radiographs was 3.5 mm (range, 0 to 8 mm), which was significantly more than that measured on three-dimensional computed tomography scans (mean, 0.3 mm; range, 0 to 1.9 mm) (p ≤ 0.001). Mean displacement on internal oblique radiographs of the elbow was 6.6 mm (range, 0 to 10.5 mm) and matched the anterior displacement measurement on the three-dimensional computed tomography scan in three of the six patients (p = 0.037). Five of the six fractures with >1 cm of displacement by three- dimensional computed tomography scan underwent surgical treatment. Conclusions: Standard radiographs (anteroposterior and lateral views) are not sufficient to measure anterior displacement nor accurate enough to measure medial displacement of medial humeral epicondylar fractures. Internal oblique radiographs of the elbow appear to approximate the true anterior displacement, but three-dimensional computed tomography is the most accurate method to assess true displacement. The results of this study demonstrate that fractures that are found to be minimally displaced or nondisplaced by radiographs may have >1 cm of anterior displacement, for which surgery is usually recommended. Level of Evidence: Diagnostic Level I. See Instructions to Authors for a complete description of levels of evidence.


Related Articles

  • Imaging sports-related elbow injuries. O’Dell, M. Cody; Urena, Joel; Fursevich, Dzmitry; Sanchez, Edward; LiMarzi, Gary; Bancroft, Laura // Applied Radiology;Mar2015, Vol. 44 Issue 3, p7 

    No abstract available.

  • Radiology of acute elbow injuries. Jacob, A. D. C.; Khan, S. H. M. // British Journal of Hospital Medicine (17508460);Jan2010, Vol. 71 Issue 1, pM6 

    The article presents an interpretation on of the radiology of acute elbow injuries. It explains that the anterior humeral line crosses the middle third of the capitellum on a lateral radiograph. It also explains that a displaced anterior fat pad is highly suspicious of fracture, even without an...

  • Multidetector computed tomography diagnosis of adult elbow fractures. Haapamaki, V. V.; Kiuru, M. J.; Koskinen, S. K. // Acta Radiologica;Feb2004, Vol. 45 Issue 1, p65 

    Purpose: To assess acute phase multidetector computed tomography (MDCT) findings in elbow traumas. Material and Methods: Fifty-six patients (32 M, 24 F, age 16 to 88 years, mean 44 years) underwent MDCT of the elbow due to an acute trauma during a time period of 34...

  • Today Paris, tomorrow the world. Greenhalgh, Trisha // Accountancy;Dec97, Vol. 120 Issue 1252, p24 

    Focuses on tennis elbow and related problems. Etiology; Pathophysiology; Complications.

  • Professor Ossolotch.  // Current Science;11/16/2007, Vol. 93 Issue 6, p15 

    The article presents information about tennis elbow, a painful injury to a tendon in the elbow.

  • Physical and psychosocial risk factors for lateral epicondylitis: a population based case-referent study. Haahr, J P; Andersen, J H // Occupational & Environmental Medicine;May2003, Vol. 60 Issue 5, p322 

    Provides information on a study that assessed the importance of physical and psychosocial risk factors for lateral epiconylitis or tennis elbow. Methodology of the study; Results and discussion on the study; Conclusion.

  • Tennis elbow. Foley, Anthony E. // American Family Physician;8/1/1993, Vol. 48 Issue 2, p281 

    Focuses on tennis elbow or lateral epicondylitis, caused by pathologic processes in the elbow. Illustrative case; Diagnosis; Treatment; Rehabilitation.

  • Bilateral Hahn–Steinthal fracture: a case report and review of literature. Manasseh Nithyananth, J.; Cherian, Vinoo Matthew; Venkatesh, K.; Amritanand, Rohit // European Journal of Orthopaedic Surgery & Traumatology;Jul2008, Vol. 18 Issue 5, p395 

    Capitellar fractures are rare. If anatomy is not reconstructed accurately, elbow function is sub-optimal. Various studies have shown good outcome in Type I Hahn–Steinthal fractures. There is only one report of a bilateral capitellar fracture in the English literature so far. We report...

  • WHAT THEY FORGOT TO TELL YOU... TENNIS ELBOW.  // GP: General Practitioner;10/20/2003, p54 

    The article presents information about the treatment of tennis elbow. Warn the patient that this is painful and may produce a dimple at the injection site, especially in thin people. Locate the area of maximum tenderness usually distal to lateral epicondyle and clean the skin. Inject lignocaine...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics