Suspected medial epicondylar fracture of humerus in a 4 year old child requires:
A i.e. X- Ray both arms with elbow for comparison The ossification centre of medial epicondyle of humerus appears between 5 - 7 years and fuses to the shaft (diaphysis) between 16 - 20 years. In older patients (> 7yr.) the medial epicondyle fragment is usually easily identified radio graphically. However radiographic interpretation is very difficult in younger patients In either case, assessment of minimally displaced fractures may be facilitated with comparison views of both elbowsQ to establish the normal width of the cailagenous space between the metaphysis and medial epicondyle. Although medial joint space widening may be present on AP radiograph, a non centrically reduced ulno - humeal joint on lateral view is often the only radiographic finding. Thus whenever a medial epicondylar fracture is suspected, it is imperative to obtain true lateral radiograph. The inability to obtain a true lateral radiograph should raise the suspicion of an entrapped medial epicondyle fragment.
X-ray both arms with elbow for comparison
X-ray same limb only
Examination under general anaesthesia
POP in full flexed position