Pediatric emergency medicine trisk 3465 3465
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epicondyle (4 to 6 years old), but this injury is not typically intra-articular ( Fig.
111.21 ). Clinically, children often present with the elbow held in flexion and with
swelling and tenderness localized to the medial aspect of the elbow, with valgus
instability (most readily demonstrated by stress radiographs). Oblique radiograph
views in addition to stress and comparison views may be needed for diagnosis.
Additional imaging with MRI examination may prove useful in defining the
extent of the injury. Nondisplaced fractures are managed in the emergency setting
with casting or posterior splinting with the elbow in flexion and neutral position,
or pronation for 3 weeks with outpatient orthopedic follow-up. Indications for
surgical management are widely debated and evidence is limited except for cases
of incarcerated fracture fragment within the joint. Orthopedic consultation is
advised in patients with neuropathy, valgus instability, or fracture fragment
displacement >2 mm.
