Proximally displaced medial humeral epicondyle fracture in pediatric patients: A clinical case series

Proximally displaced medial humeral epicondyle fracture in pediatric patients: A clinical case series | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article Proximally displaced medial humeral epicondyle fracture in pediatric patients: A clinical case series Lujie Xu, Wensong Ye, Haibing Li, Jingfang Xu, Weiwei Zhu, Yi Yang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-32733/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Medial epicondyle fracture comprises a considerable proportion of pediatric elbow injury. The fracture fragment is typically pulled distally by the muscle and the ligament. This study aims to suggest proper recognition of a subset of the fracture that differs from its usual presentation. Methods A retrospective case study was conducted during 2011–2016. Of those cases, a subset was identified as proximally displaced (atypical) ones. Distinctive radiologic images, as well as the injury causes, demographic data, clinical signs, treatment ways, and final follow-ups regarding these atypical ones, were presented and discussed. The fracture mechanism was carefully inferred from former theories and the operative findings, and a tentative management strategy was suggested. Results Seven out of 112 cases were distinguished as the atypical, which represents 6.25% of the whole sample. Injury causes were all direct or combined direct/indirect force injuries instead of indirect force mostly seen in the typical. Five were operated while two nonoperatively treated. Operated cases revealed stripping of medial epicondyle from its surrounding periosteum/muscle origin or even cartilage. The fracture fragment was either pulled by proximal periosteum or even proximally dissociated. The outcomes of those atypical were mostly acceptable despite some minor defects. Conclusion The proximally displaced cases do constitute a portion of medial humeral epicondyle fracture in children. As well as its skeletal manifestation, awareness of its injury mechanism and soft tissue damage is required. Precise restoration of its anatomical structure might be vital for its treatment. Further scientific work is needed regarding its mechanism and management. Level of evidence: Level 4. Orthopedics Medial humeral epicondyle fracture Pediatric Children Proximally displaced Atypical Figures Figure 1 Figure 2 Figure 3 Full Text Supplementary Files CaseInfo.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-32733","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":647485,"identity":"33174ada-24b8-4644-898c-25d3ec318307","order_by":0,"name":"Lujie Xu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA00lEQVRIiWNgGAWjYFAC5gYGCQMGOQaGA0AOG1FaGMFajEnUAgSJYJIoLQY3EtskLAps0uc3njFg+FB2mIF/dgN+LZIzgFokDNJyGxvOGDDOOHeYQeLOAfxa+CXAWg7nNjOcMWDmbTvMYCCRgF8LG0TL/3Q2kJa/xGiB2nIggQekhZEYLZI9D5stJAySDWcwHCs42HMunUfiBgEtBseTD96W+GMnLz/j8MYHP8qs5fhnENACAswSIFLiADgyeQirBwLGDyCSv4EoxaNgFIyCUTACAQD9yj7wlcSmnAAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0003-2822-6549","institution":"Zhejiang University School of Medicine Children's Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Lujie","middleName":"","lastName":"Xu","suffix":""},{"id":647486,"identity":"21f6b2e2-5f12-4a85-beb5-f87f9ba8ce5c","order_by":1,"name":"Wensong Ye","email":"","orcid":"","institution":"Zhejiang University School of Medicine Children's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wensong","middleName":"","lastName":"Ye","suffix":""},{"id":647487,"identity":"fef7b0c3-3fba-4c85-a30e-b6db7bcda268","order_by":2,"name":"Haibing Li","email":"","orcid":"","institution":"Zhejiang University School of Medicine Children's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Haibing","middleName":"","lastName":"Li","suffix":""},{"id":647488,"identity":"677a726e-e775-4606-873b-b59f8d42e927","order_by":3,"name":"Jingfang Xu","email":"","orcid":"","institution":"Zhejiang University School of Medicine Children's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jingfang","middleName":"","lastName":"Xu","suffix":""},{"id":647489,"identity":"0156731d-c33c-42c6-bea9-9c640735549f","order_by":4,"name":"Weiwei Zhu","email":"","orcid":"","institution":"Zhejiang University School of Medicine Children's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Weiwei","middleName":"","lastName":"Zhu","suffix":""},{"id":647490,"identity":"a21a498c-97b7-4ee4-b79b-83cf8302f2ae","order_by":5,"name":"Yi Yang","email":"","orcid":"","institution":"Zhejiang University School of Medicine Children's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yi","middleName":"","lastName":"Yang","suffix":""}],"badges":[],"createdAt":"2020-05-30 22:46:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-32733/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-32733/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":1293170,"identity":"84f5ff7f-72a6-467c-bd68-1e60a730b681","added_by":"auto","created_at":"2020-06-09 20:48:41","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":298992,"visible":true,"origin":"","legend":"Multiple 3D-CT appearances of proximally displaced medial humeral epicondyle fracture. \na. Fragment displaced proximally and rotated posteriorly with part of the epicondyle attached to the humeral metaphysis (Case #1). \nb. Fragment displaced and rotated proximally (Case #2). \nc. Fragment displaced anteriorly proximally (Case #3). \nd. Fragment slightly displaced anteriorly and proximally (Case #5).","description":"","filename":"fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-32733/v1/fig1.png"},{"id":1293171,"identity":"b04de93d-2e9b-4d3f-8bf7-a177027bf817","added_by":"auto","created_at":"2020-06-09 20:48:42","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":623986,"visible":true,"origin":"","legend":"The comparison of typical (a, c, e) and atypical (b, d, f) medial epicondyle fracture in radiologic images (a, b), intraoperative findings (c,d), and illustrative sketches (e,f). \na. 3D image of the typical medial humeral epicondyle fracture showing distally displaced epicondyle.\nb. Atypical one showing proximally displaced epicondyle.\nc. Typical one showing the epicondyle beneath the musculus flexor, tear between epiphyseal periosteum and the periosteum around epicondyle.\nd. Atypical one showing bare epicondyle, tear between epiphyseal periosteum and the periosteum around epicondyle, also tear between epicondyle and its surrounding periosteum.\ne. Sketch of typical one showing rupture of epiphyseal periosteum, intact UCL, and attachment of surrounding epicondyle periosteum.\nf. Sketch of atypical one showing avulsion between epicondyle and its surrounding cartilage and periosteum. UCL is ruptured, epicondyle is pulled proximally by the attached epiphyseal periosteum.\n1. Epiphyseal periosteum \n2. The epicondyle and its migrate direction \n3. The periosteum and cartilage surrounding epicondyle \n4. The ulnar collateral ligament (UCL) \n5. The flexor-pronator mass.","description":"","filename":"fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-32733/v1/fig2.png"},{"id":1293172,"identity":"be12205c-fa00-49f9-92ca-84999d0e019a","added_by":"auto","created_at":"2020-06-09 20:48:42","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":505346,"visible":true,"origin":"","legend":"Operative treatment for illustrative case #1 (a, b) and case #2 (c, d). A and c show immediate postoperative X-rays and b and d show two months follow-up X-rays. White arrows show heterotopic ossification near epicondyle. Preoperative images see Fig. 1a and Fig. 1b respectively.","description":"","filename":"fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-32733/v1/fig3.png"},{"id":1293175,"identity":"170abf0b-ff66-4ebc-83f8-4ac771e84597","added_by":"auto","created_at":"2020-06-09 20:48:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2186235,"visible":true,"origin":"","legend":"","description":"","filename":"Manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-32733/v1_stamped.pdf"},{"id":1293173,"identity":"dce9af49-6d26-4d02-b48c-f616d590eb36","added_by":"auto","created_at":"2020-06-09 20:48:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2122617,"visible":true,"origin":"","legend":"","description":"","filename":"Manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-32733/v1/Manuscript.pdf"},{"id":13508582,"identity":"0310c2d9-5023-4afa-9086-aaed99ae2cfc","added_by":"auto","created_at":"2021-09-16 23:40:06","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2257963,"visible":true,"origin":"","legend":"","description":"","filename":"Manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-32733/v1_covered.pdf"},{"id":1293174,"identity":"cc4f5d5c-6af2-4c8f-b25e-4b2d97a18fa3","added_by":"auto","created_at":"2020-06-09 20:48:42","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":17031,"visible":true,"origin":"","legend":"","description":"","filename":"CaseInfo.docx","url":"https://assets-eu.researchsquare.com/files/rs-32733/v1/CaseInfo.docx"}],"financialInterests":"","formattedTitle":"Proximally displaced medial humeral epicondyle fracture in pediatric patients: A clinical case series","fulltext":[{"header":"Full Text","content":"\u003cp\u003eThis preprint is available for \u003ca href='/article/rs-32733/latest.pdf' target='_blank'\u003edownload as a PDF\u003c/a\u003e.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Medial humeral epicondyle fracture, Pediatric, Children, Proximally displaced, Atypical","lastPublishedDoi":"10.21203/rs.3.rs-32733/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-32733/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMedial epicondyle fracture comprises a considerable proportion of pediatric elbow injury. The fracture fragment is typically pulled distally by the muscle and the ligament. This study aims to suggest proper recognition of a subset of the fracture that differs from its usual presentation.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective case study was conducted during 2011\u0026ndash;2016. Of those cases, a subset was identified as proximally displaced (atypical) ones. Distinctive radiologic images, as well as the injury causes, demographic data, clinical signs, treatment ways, and final follow-ups regarding these atypical ones, were presented and discussed. The fracture mechanism was carefully inferred from former theories and the operative findings, and a tentative management strategy was suggested.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSeven out of 112 cases were distinguished as the atypical, which represents 6.25% of the whole sample. Injury causes were all direct or combined direct/indirect force injuries instead of indirect force mostly seen in the typical. Five were operated while two nonoperatively treated. Operated cases revealed stripping of medial epicondyle from its surrounding periosteum/muscle origin or even cartilage. The fracture fragment was either pulled by proximal periosteum or even proximally dissociated. The outcomes of those atypical were mostly acceptable despite some minor defects.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe proximally displaced cases do constitute a portion of medial humeral epicondyle fracture in children. As well as its skeletal manifestation, awareness of its injury mechanism and soft tissue damage is required. Precise restoration of its anatomical structure might be vital for its treatment. Further scientific work is needed regarding its mechanism and management.\u003c/p\u003e\u003ch2\u003eLevel of evidence:\u003c/h2\u003e \u003cp\u003eLevel 4.\u003c/p\u003e","manuscriptTitle":"Proximally displaced medial humeral epicondyle fracture in pediatric patients: A clinical case series","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-06-09 20:48:41","doi":"10.21203/rs.3.rs-32733/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1ef6b509-3b4b-45f7-8f1e-f966b26903b5","owner":[],"postedDate":"June 9th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":116724,"name":"Orthopedics"}],"tags":[],"updatedAt":"2020-09-23T17:23:57+00:00","versionOfRecord":[],"versionCreatedAt":"2020-06-09 20:48:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-32733","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-32733","identity":"rs-32733","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}