Nonunion of humeral medial condyle fracture caused by excessive functional exercise: a case report and review of the literature

Abstract

Background: Medial epicondyle fractures are one of the more common humerus fractures, but humeral medial condyle fracture (HMCF) is rare. Nonunion of medial humeral condyle fractures due to functional exercise is less common.

Case presentation: We report a 5-year-old patient with a nonunion HMCF due to excessive functional exercise, who bruised the elbow 1 year ago and had no positive findings on all imaging studies. On this physical examination, there was a snapping and palpable lump in the elbow joint during movement, but the patient did not feel any discomfort and the range of motion of the joint was normal. X rays and computed tomography (CT) showed that the left HMCF was discontinuous, the broken ends were dislocated, and the joint alignment was poor. Open reduction (OR) and screw fixation was used during the operation, and the patient recovered well at 3-month follow-up.

Conclusions: The rarity and low radiographic appearance of displaced HMCF are easily overlooked and can eventually lead to nonunion HMCF, especially when radiographically difficult to visualize before age 5 years. Therefore, regardless of whether there are signs or imaging abnormalities in the growth process of adolescents, they should be vigilant, shorten the time interval for re-examination, and early detection and timely treatment can avoid some complications caused by this.

Keywords: Children; Functional exercise; Medial humeral condyle fracture; Osteotomy; Screw fixation.

Fig. 1

Imaging features of patients. A 3D-CT of the elbow 1 year ago, no abnormality was seen. B This MRI showed poor joint alignment and joint effusion. C Falling debris is clearly visible in the 3D reconstructed image. D X-ray examination can clearly show that the bone cortex is discontinuous and the broken ends are dislocated

Fig. 2

Internal fixation of HMCF. A Find the ulnar nerve to separate and protect it. B Enter the joint cavity to find the fracture end and bone fragments. C-D The bone fragments and the medial condyle fragment can be seen after ossification. E The separated bone fragments, 3 × 2x1cm size. F Two hollow metal screws fixed

Fig. 3

Intraoperative and postoperative X rays. A Using Kirschner wire for positioning. B Using metal screw fixation. C-D Postoperative X-ray appearance after cast immobilization