Medial epicondyle fracture of the humerus ed smith. The medial epicondyle provides attachment of the ulnar collateral ligament to the pronator teres muscle. The avulsed and displaced medial epicondyle m is marked in red, whereas the normal centers of ossification are marked in white. The epicondyles provide attachment for muscles and supporting. They account for approximately 8% of all fractures in the elbow region,1 and 14% involve incarceration of the fragment. Medial epicondyle fracture of the humerus fracture clinics. Adductor tubercle is a projection posterosuperior to the epicondyle which serves as an important landmark. Medial epicondyle fractures of the humerus request pdf. Here are the xrays from a four year old child who has a fracture of the lateral epicondyle. The femoral insertions of the lcl and popliteus tendon should be identified and included in the planned osteotomy. Directly below it is a small depression from which a smooth wellmarked groove curves obliquely upward and backward to the posterior extremity of the condyle. According to laprade and coworkers, 28 the smcl does not attach directly to the medial epicondyle of the femur, but is centered in a depression 4. Jan 10, 2017 keywords avulsion fractures casting and immobilization child abusenonaccidental trauma nat distal humerus physeal separation distal femur physeal fracture pediatric hip dislocation pediatric hip fracture humeral shaft fractures lateral condyle fracture medial epicondyle fracture pediatric ankle fractures pediatric forearm fracture pediatric clavicle fracture pediatric distal radius.
Medial epicondyle of femur definition of medial epicondyle. What are the potential complications associated with this injury. The medial epicondyle is situated below and anterior to the adductor tubercle. Directly below it is a small depression from which a smooth wellmarked groove curves obliquely upward and backward to. The medial epicondyle creates a prominent, blunt protuberance on the medial side of the condyle and it, is the point where the medial border of the humerus terminates by curving marginally towards the back. A medial epicondyle fracture is a type of broken elbow seen in kids.
Surgery, childrens hospital of philadelphia, main campus 34. Knowledge of precise anatomic landmarks and relationships of the distal femur can be helpful in knee surgery, especially primary and revision. It is cylindrical, projecting in a superior and medial direction this angle of projection permits for an enhanced range of movement at the hip joint. Include any exams preformed under anesthesia positioning describe and provide or photos to illustrate p. It is the small, laterally directed eminence of the lateral condyle. Located at the distal end of the femur posterior of the femur 2. Operative fixation of medial humeral epicondyle fracture. The superior third of patella acts as the attachment point for the tendinous. The medial epicondyle of the femur is a bony protrusion located on the medial side of the bones distal end. The medial and lateral epicondyle as a reliable landmark for. These fractures, affecting the bony protrusion on the inside of the elbow, are the most common. The smcl is a welldefined structure that spans the medial joint line from the femur to tibia.
In adults, this medial prominence is completely bony, but in children, the medial epicondyle is composed of an ossification center of cartilage and bone. Anatomy, bony pelvis and lower limb, knee statpearls ncbi. The location of the femoral origin of the mpfl is between the adductor tubercle and the medial epicondyle. Medial femoral condyle musculoskeletal, skeletal anatomyzone. Outcome was assessed with radiographs and a questionnaire that included 3 selfreported functional outcome tools at a mean of 4. Mar 20, 2020 the major controversy involving medial epicondyle fractures has involved the management of displaced fractures. Use critoe to determine if bone in joint is medial epicondyle or nl trochlear oss center if think is trochlear but cannot see medial epicondyle fragment is medial epicondyle medial epicondyle normally ossifies before the. It is the small, medially directed eminence of the medial condyle.
Street and civic center boulevard, philadelphia, pa 191044399, usa, tel. Nondisplaced medial epicondyle fractures of humerus are best treated by conservative methods whereas incarcerated intraarticular displaced fractures, fractures with ulnar nerve entrapment, and unstable fractures should be treated with open reduction and internal fixation orif. Arthroscopic removal of loose joint bodies of the right elbow. The medial epicondyle of the femur is a bony protrusion located on the medial side of the bones distal end located above the medial condyle, it bears an elevation, the adductor tubercle, which serves for the attachment of the superficial part, or tendinous insertion, of the adductor magnus. Arm a rounded projection of the distal humerus and point of attachment of the pronator teres, common tendon of origin for the long palmar, radial flexor of wrist, superficial flexor of finger and ulnar flexor of wrist, and the ulnar collateral ligament. Medial epicondyle fractures of the humerus are the third most common pediatric elbow fracture and account for approximately 12% of all elbow fractures in children. It is important to distinguish a medial epicondyle fracture common from a medial condyle fracture very rare. Methods eight patients with symptomatic medial humeral epicondyle nonunions were evaluated after open reduction and internal fixation of the medial epicondyle. Compared to the medial epicondyle, which goes slightly backward, lateral epicondyle goes a little forward.
Anatomy, bony pelvis and lower limb, femur statpearls ncbi. Medial collateral ligament an overview sciencedirect. The main difference between condyle and epicondyle is that condyle forms an articulation with another bone. Medial epicondyle fracture radiology reference article. This is the attachment site of the tibial collateral ligament. The surgical treatments are considered when the fracture fragment is displaced into the elbow joint, when ulnar. Keywords avulsion fractures casting and immobilization child abusenonaccidental trauma nat distal humerus physeal separation distal femur physeal fracture pediatric hip dislocation pediatric hip fracture humeral shaft fractures lateral condyle fracture medial epicondyle fracture pediatric ankle fractures pediatric forearm fracture pediatric clavicle fracture pediatric distal radius. Located at the distal end of the femur posterior of the femur 1 medial condyle of the femur. Based on the results of this study, we suggest that during the practice of chemical neurolysis treatment to thigh adductor muscles spasticity, one could measure on body surface the length between greater trochanter of femur and pubic tubercle h line, and the length from greater trochanter of femur to lateral epicondyle of femur l line.
Surgical anatomy part of 41 fractures of the shaft of the femur the shaft of the femur is essentially a tubular structure. The knee is the largest synovial joint in the body. The transepicondylar width tew, the distance from the medial epicondyle to both the distal and posterior articular joint lines, and the distance from the lateral epicondyle to both the distal and posterior articular joint lines were measured in 40 knees from 20 formalinfixed adult cadavers. Oct 18, 2017 the main difference between condyle and epicondyle is that condyle forms an articulation with another bone. Medial condyle fractures involve a fracture line that extends through and separates the medial metaphysis and epicondyle from the rest of the humerus see image below.
Femurs are short, flared at the metaphyses with a medial spike, and are bowed type i or straight. Epicondylus medialis femur, epicondylus medialis femoris description. During this time of rapid growth, the growth plate cartilage throughout the body is most susceptible to injury. How often should these fractures be followed up in fracture clinics. The medial epicondyle is a particularly important landmark, as the ulnar nerve passes around its posterior aspect to enter the forearm it can easily be compressed or damaged at this location. Pdf difference between condyle and epicondyle researchgate. Chronic dislocation right elbow with avulsion of the lateral epicondyle and multiple loose joint bodies. Note that as the lateral external epicondyle is present l a medial epicondyle should be easily seen. Medial epicondyle fractures of the humerus account for 1220% of pediatric elbow fractures.
Sams clinical history 10yearold male with right elbow pain after a fall from a horse. The block extends approximately 15 mm into the cancellous bone. Mar 20, 2020 medial humeral condyle fracture with an ipsilateral dislocated radial head. Medial collateral ligament of the knee physiopedia. The fracture occurred when the child fell onto her outstretched hand a mechanism of injury that we call a foosh while running on a playground. It also bears a prominent point called the medial epicondyle. Our elbow is a joint where the arm bone humerus meets up with your two forearm bones the radius and the ulna. Davies, christopher philip, in equine podiatry, 2007. Located above the medial condyle, it bears an elevation, the adductor tubercle, which serves for the attachment of the superficial part, or tendinous insertion, of the adductor magnus. An oscillating saw is used to cut a larger bony block around a screw hole predrilled in the lateral femoral epicondyle. By henry vandyke carter henry gray 1918 anatomy of the human body see book section. The bony tommy john injury medial epicondyle fractures.
The typical mechanism is a fall onto an outstretched hand, creating a valgus load at the elbow leading to avulsion of the epicondyle from pull of either the flexorpronator mass or ulnar collateral ligament. Discussion detailed anatomic descriptions of the epicondyles of the distal femur are scarce. The attachment of the remainder of the fiber to the fascia and tendon of the. Failure to diagnose these injuries can lead to significant long term disability. Medial epicondyle the medial epicondyle is located above the medial condyle hence the prefix epi, and it provides attachment of the adductor magnus and gastrocnemius muscles. Distally the linea aspera forms two ridges known as the lateral supracondylar line. Behind it, and proximal to the medial condyle is a rough impression whic. Specifically in passive flexion of the elbow, it is subcutaneous and generally noticeable. A medial epicondyle avulsion fracture is an elbow injury that occurs most often in young baseball players between the ages of 9 and 14. For the superficial group of the extensor muscles of the forearm, its lateral as well as anterior surfaces show a wellmarked indentation, which arise from the lower humeral epiphysis at the lateral side and they are extracapsular just. This condition is characterized by irritation and inflammation of the growth. The skin is incised from the lateral epicondyle of the humerus on a line following the craniolateral border of the radius to the junction of the proximal and middle one third of the bone b. Medial epicondyle fracture of the humerus emergency department.
The bones of the knee joint comprise the femur thigh bone, tibia. The shaft of the femur is smooth along its anterior, medial, and lateral surfaces. The distal end of the femur has medial and lateral bony expansions. Repair, lateral epicondyle nonunion orthopedic coding.
Medial condyle fractures are intraarticular, extending into the elbow joint and require urgent op. Figure 16a figure 16b figure 16c findings anteroposterior fig. It is larger and further back on the bone than its counterpart the lateral epicondyle. Medial epicondyle of humerus musculoskeletal, skeletal. Neck attaches the head of the femur with the shaft. The medial femoral condyle can be palpated in the flexed knee, medial to the patellar ligament, from the. Nov 01, 2012 furthermore, surgical fixation appears to be better than nonsurgical treatment in medial humeral epicondyle fracture without associated elbow dislocation, because more bony union can be achieved and one patient with pseudarthrosis complained difficulty during performing overhead throwing motion. Treatment of symptomatic medial epicondyle nonunion. Open repair of a nonunion of the lateral epicondyle. The distal end of the femur forms two rounded condyles which articulate with the tibia below and the patella anteriorly the medial condyle and the lateral condyle. The pcl attaches at the medial condyle of the femur and the. The medial epicondyle is more prominent than the lateral epicondyle.
Fractures of the medial epicondyle are a common pediatric injury, representing 12% to 20% of all pediatric elbow fractures 1, 2, 3. While this can spare the vital organs from injury, it can also place the bones of the arm at risk. Medial epicondyle apophysitis, often called little league elbow, is the most common injury affecting young baseball pitchers whose bones have not yet stopped growing. The child was evaluated in the emergency department and taken to the operating room on the same day for closed reduction and percutaneous pin fixation of her lateral epicondyle fracture. The precise location of the femoral attachment of the mpfl has been recently delineated in cadaveric dissections by laprade et al. Sesamoid bone of the medial collateral ligament of the knee joint. Contemporary literature, however, universally refers to the medial epicondyle as the medial prominence of the distal humerus. The structure indicated is the medial condyle of the femur the distal end of the femur forms two rounded condyles which articulate with the tibia below and the patella anteriorly the medial condyle and the lateral condyle the linea aspera is a roughened crest of bone on the posterior aspect of the femur. This serves as the attachment of the fibular collateral ligament. The medial epicondyle is the attachment site for the forearm muscles used in throwing and helps to stabilize the elbow during the throwing motion. Part of the upper arm bone, or humerus, it occurs at the bottom of the bone where the humerus meets the ulna at the elbow. This landmark name arises from the greek epi meaning upon and kondulos or knuckle. The rugose areas for muscular attachment proximal to the condyles are the lateral and medial epicondyles.
It travels downwards and forwards from the medial epicondyle of the femur to the medial condyle and upper medial shaft of the tibia. It has a glossy surface with a depression on the medial position. Medial femoral condyle the structure indicated is the medial condyle of the femur. It also provides attachment for the tendon of adductor magnus muscle as well as the. Learn vocabulary, terms, and more with flashcards, games, and other study tools. The femoral attachment is situated on the medial epicondyle. Medial humeral epicondyle fractures are relatively common in older children and adolescents, and are associated with elbow dislocation in 3050% of cases. The bones of the knee comprise the femur thigh bone, tibia shin bone, patella kneecap, and to a lesser degree the fibula.
They have demonstrated variable outcomes following open reduction and internal fixation of medial epicondyle fractures that are associated with intraarticular incarceration. It is composed of 3 bones and 3 joints although 2 of the 3 joints share a common cavity. Here are the intraoperative carm pictures of the fracture after percutaneous pinning. Fractures of the medial epicondyle are relatively rare injuries in children. The deep antebrachial fascia is incised on the same line as the skin. Anatomy, bony pelvis and lower limb, knee patella statpearls. Kids broken elbow medial epicondyle fracture bone talks. Medial and lateral condyle join the femur to the tibia, forming the knee joint. The origin of the meniscofemoral comes from the femur just distal to the superficial medial collateral, inserting into the medial menisci. Medial epicondyle definition of medial epicondyle by. This landmark name arises from the greek epi meaning upon and kondulos or.
Oct 11, 2017 contemporary literature, however, universally refers to the medial epicondyle as the medial prominence of the distal humerus. The code is not valid for the year 2020 for the submission of hipaacovered transactions. Lateral epicondyle definition of lateral epicondyle by. In the forelimb, the humeral belly originates from the medial epicondyle of the humerus and lies against the caudal surface of the radius, where it forms the major bulk of the muscle. Fifty percent of medial epicondyle fractures are associated with an elbow dislocation. How to walk correctly and fix your lower back pain.
Lateral and medial condyles the lateral and medial condyles are going to articulate form a joint with the patella and tibia bone of the leg, creating the. Arthroscopic anatomy of the knee joint and portals intechopen. Directly below it is a small depression from which a smooth wellmarked groove curves obliquely upward and backward to the posterior extremity of the condyle references. The lateral epicondyle of the femur, smaller and less prominent than the medial epicondyle, gives attachment to the fibular collateral ligament of the kneejoint. Troubleshooting the femoral attachment during medial. Fractures of the medial condyle and epicondyle of the elbow in children. Medial epicondyle fractures represent almost all epicondyle fractures and occur when there is avulsion of the medial epicondyle.
When should i refer for an orthopaedic consultant opinion. By definition, the fracture line must involve the trochlear articular surface. Orif of fractures of the medial epicondyle orthopaedicsone. The lateral part consists of a lateral femoral condyle, lateral tibial plateau. Lateral epicondyle definition of lateral epicondyle by the. The patellar trochlea, for articulation with the patella. It is slightly bowed anteriorly, and distally it flares outward toward the medial and lateral condyles of the supracondylar region.
The ratio for the coronal lateral epicondyle tojoint line distance to the transepicondylar width was 0. Epicondylus lateralis femur, epicondylus lateralis femoris description. At its femoral attachment some fibres continue into the adductor magnus muscle. It is a specialized part of some of the bones found in the human body. The medial epicondyle is more prominent and provides attachment for the.
This article incorporates text in the public domain from page. Displacement of medial epicondyle ossification center. When people fall, they have an instinct to extend their arms in front of their body to protect their chest and abdomen from impact with the ground. They are typically seen in children, and can be challenging to identify. Indications discuss indications and more general concerns. The deep medial ligament dmcl is divided into two, the meniscofemoral and meniscotibial ligaments. Learn more about the anatomy of the humerus in this anatomy tutorial.
Medial epicondyle avulsion fracture lurie childrens. Ta the epicondylus located proximal to the medial condyle. Femur bone anatomy landmarks and muscle attachments. Bones of the lower limb anatomy and physiology openstax. Medial epicondyle of humerus the medial epicondyle creates a prominent, blunt protuberance on the medial side of the condyle and it, is the point where the medial border of the humerus terminates by curving marginally towards the back.
This tendinous part here forms an intermuscular septum which forms the medial separation between the thighs flexors and extensors. This lesson explains what an epicondyle is, what a fracture is, and how a. Humerus medial epicondyle fractures pediatric orthopaedic. The rough crest of bone running down the posterior shaft of the femur, the vastus medialis, vastus lateralis, adductor brevis, adductor longus, adductor magnus, and short head of the biceps femoris muscles all attach to this landmark. Isolated fractures can occur secondary to direct trauma or avulsion forces. Lateral condyle is broader than medial condyle of the femur. Treatment of medial epicondyle fracture without associated. The extensor muscles, collateral radial vessels, and a cutaneous branch of the radial nerve will be exposed.
Each condyle bears a smooth, semicircular surface for articulation with the tibia. Good results have been reported with both operative and nonoperative treatment of the displaced medial epicondyle fracture. Leg a rounded projection of the distal femur above the medial chondyle. Relatively common in children, 12% of all elbow fractures in children treatment certain areas of treatment are clear. This tendinous part here forms an intermuscular septum which forms the medial separation between. Located above the medial condyle, it bears an elevation, the adductor tubercle, which serves for the attachment of the superficial part. By dr arun pal singh the femur is also called the thigh bone and is the longest and strongest bone of the body. Aug 08, 2018 a rounded protuberance on a bone that is located upon a condyle is an epicondyle.
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