A medial epicondyle avulsion fracture occurs when the bony bump on the inner side of the elbow is pulled away from the humerus by the attached ligaments and muscles. This injury is most common in children and adolescents whose growth plates have not yet fully closed. It often results from a sudden, forceful event like a fall on an outstretched hand or a high-velocity throwing motion.
This injury typically presents with immediate and significant distress following a traumatic event.
Severe Inner Pain: Intense pain localized to the bony prominence on the inner elbow.
Visible Swelling: Rapid bruising and swelling that may extend down the forearm.
Limited Motion: Inability to straighten or bend the elbow due to pain and mechanical blockage.
Numbness: Potential tingling in the small finger if the ulnar nerve is irritated by the displaced bone fragment.
Deformity: A noticeable change in the shape of the elbow if the bone fragment is significantly displaced.
Because this injury involves the growth plate, precise imaging is necessary to determine the best course of action.
Physical Examination
X-rays: The primary tool used to view the fracture. Comparison views of the uninjured elbow are often taken in pediatric cases to help distinguish the fracture from normal growth plate development.
CT Scan: Used in complex cases to measure the exact distance the bone has moved (displacement) or to see if the fragment has become trapped inside the joint.
Treatment is based on how far the bone fragment has moved from its original position.
Nondisplaced: Immobilization in a cast or splint for several weeks followed by gentle therapy.
Minimally Displaced: A brief period of casting followed by a structured range of motion program.
Severely Displaced: If the bone fragment is displaced by more than 5 to 10 millimeters, or if it is caught in the joint, surgery is usually required to prevent long term instability and weakness. Following the healing of the bone, physical therapy is essential to regain full flexibility and strength.