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- Usually 10-15 years old. Because it is the last to fuse at 17 years old
- CRITOE sequence at 1/3/5/7/9/11?
- Capitellum, Radial head, Internal (medial) epicondlyle, trochlea, olecranon, External (lateral) epicondyle
- Closure sequence
- 12 yo, E, C, T start to fuse together
- 15 yo ECT fuse to humerus, O and R fuses
- 17 yo medial condyle fuses
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- Elbow dislocation
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- Ulnar nerve - 10-16% reported neuropraxia
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- Distal humeral axial view - beam angled 25 degrees anterior to long axis of humerus
- souder2015.pdf
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- Undisplaced < 2mm ➔ Conservative in above elbow cast
- Displaced > 2mm ➔ Op
- Indications for surgery: displaced > 2mm, incarcerated, large fragment
- Aware that some studies show no differences in ROM, functional outcomes, return to sports despite being displaced by
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- Direct Medial approach to medial epicondyle via inter-nervous plane between Flexor pronator mass and brachialis (MCN) // Triceps (radial n.)
- Same but opposite approach to lateral condyle - direct lateral between brachialis and triceps
- Identify and protect ulnar nerve
- Due to the pull of the flexor pronator mass, can use esmarch technique to push the fragment proximally
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- Screw vs wire vs Suture anchor
- Kathleeen Ricket et al. JPO 2020
- Screw construct strongest and stiffest
- Screw fixation offers shorter casting duration but greater implant removal need with higher associated costs
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- Surgery or Cast for Injuries of the EpicoNdyle in Children’s Elbows
