Not a true physeal injury; medial epicondyle is an apophysis and does not contribute to humeral length…this is not a true Salter-Harris injury

Peak age 9-12 years

Acounts for 13% of all distal humerus fractures in children

50% are associated with elbow dislocations

Mechanism of injury: valgus force on elbow joint

Apophyseal fragment displaces distally, becoming incarcerated in the elbow joint ~18% of time

Most important step in management is ruling out concomittant injury

Gross instability: possible elbow dislocation

Fat pad sign on x-ray: possible medial condyle fracture / intrarticular pathology

Severe swelling, be wary of compartment syndrome


Operative Indications

1. Open fracture

2. Irreducible incarceration of fragment in elbow joint

No consensus exists in the literature in terms of acceptable amount of displacement

Nonoperative Treatment

Reduction maneuver: Valgus stress with wrist extension

Long arm cast

Jossefson et al Acta Orthop Scand 1986; 56 displaced straight forward med epi fx’s tx’d non-op displacment ranged 1-15mm: "very good function and ROM expected" long term with immobilization alone

Wilson et al Injury 1988; 20 non-op 23 op treatment: operative treatment had better radiographic reduction, higher union rate, BUT higher rate of minor symptoms (ulnar neuropathy, pain decreased ROM)

Operative Treatment

CRPP vs. cannulated lag screw