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Medial Epicondyle Fracture S42.442A 812.43

medial epicondyle fracture xray

medial-epicondye-fracture-cases

elbow bony anatomy picture

elbow cross section image

medial epicondyle fracture CT scan

medial epicondyle fracture ORIF xray

medial epicondyle fracture ORIF xray

synonyms: medial epicondyle fracture

Medial Epicondyle Fx ICD-10



 

A- initial encounter for closed fracture

B- initial encounter for open fracture

D- subsequent encounter for fracture with routine healing

G- subsequent encounter for fracture with delayed healing

K- subsequent encounter for fracture with nonunion

P- subsequent encounter for fracture with malunion

S- sequela

Medial Epicondyle Fx ICD-9

  • 812.43 (closed medial condyle fracture)
  • 812.53(open)

Medial Epicondyle Fx Etiology / Epidemiology / Natural History

  • Uncommon

Medial Epicondyle Fx Anatomy

  • Primary constraints=ulnohumeral articulation(coronoid), medial collateral ligament(MCL), lateral collateral ligament(LCL)  (King GJ, JSES 2;165:1993).
  • Secondary constraints=radial head, common flexor and extensor origins, capsule. (Morrey BF, CORR 1991;265:187).
  • Dynamic constaints=mucles which cross the elbow, mainly the triceps, anconeus and brachialis.
  • Anterior band of medial collateral ligament is the primary constraint to valgus instability.
  • LCL(ulnar part) is primary constraint to posterolateral rotatory instability
  • Pathoanatomy of dislocation is a circle of bone/soft tissue disruption starting laterally and progressing medially.   Stage I=ulnar band of LCL, Stage II=ant/post capsule, Stage III=MCL disrupted, anterior band of MCL is the last to disrupt.
  • Most dislocations have disruptions of both the MCL and LCL.
  • (McKee MD, JSES 2003;12:391).
  • See also Elbow Anatomy.

Medial Epicondyle Fx Clinical Evaluation

  • Generally present with obvious deformity, pain and swelling.
  • Document NV exam.
  • Lateral pivot shift test=for posterolateral rotatory instability- pt supine, arm overhead.  Supination-valgus moment applied during flexion, elbow subluxates usually at @40degrees, additional flexion causes reduction/clunk.  Should create apprehension. 
  • Valgus and varus stress, both in extension and 30 degrees flexion.
  • Valgus stress testing performed in full pronation to eliminated posterolateral rotatory instability.
  • Document wrist evaluation.

Medial Epicondyle Fx Xray / Diagnositc Tests

  • A/P and lateral elbow films demostrates dislocation and associated fractures.
  • Consider CT scan if fracture fragment is not clearly seen on xray.

Medial Epicondyle Fx Classification / Treatment

  • 24566 (percutaneous fixation of humeral epicondylar fracture, medial or lateral , with manipulation)
  • 24575 (open treatment of humeral epicondylar fracture, medial or lateral, with or without internal or external fixation)
  • 24582 (percutaneous fixation of humeral condylar fracture, medial or lateral , with manipulation)
  • 24579 (open treatment of humeral condylar fracture, medial or lateral, with or without internal or external fixation)
  • 24586 (open treatment of periarticular fracture and/or dislocation of the elbow; fracture distal humerus and proximal ulna and or proximal radius)

Medial Epicondyle Fx Associated Injuries / Differential Diagnosis

Medial Epicondyle Fx Complications

Medial Epicondyle Fx Follow-up Care

  • Bulkly dressing with posterior splint post-operatively
  • 7-10 day post-operative: Splint removed, ROM in a hinged elbow brace is started with ROM determined by security of fixation achieved at surgery.
  • See also Elbow Outcome Measures.

Medial Epicondyle Fx Review References