Slide 125 — Paediatric medial epicondyle fracture

Clean FRCS notes with inline figures

•Fracture medial epicondyle with displacement of the fragment into the UHJ

•Associated with *elbow dislocation

Classification

•Watson Jones

•I <5mm displacement with no rotation

•II >5mm displacement with rotation

•III incarcerated fragment without dislocation

•IV incarcerated fragment with dislocation

History

•Mechanism of injury

•Chronicity of injury

•Any dislocation episode

Examination

•Check ulnar nerve

•Check wound

Management

Indication for surgery

•Absolute: incarcerated fragment

•Relative: >5mm displacement, valgus instability

•Reduction maneuvers: Roberts

•supination + valgus + wrist extension

•Fix with lag screw, K wire, absorbable pin

•Typical age: Age 11-14

•Mechanism

•Fall on outstretched hand

•Associated with elbow dislocation (up to 50%) – fragment may be incarcerated in the joint

•Overuse by overhead throwing athlete (little leaguer elbow)

Pathoanatomy

•Last ossification center to fuse

•At posteromedial aspect of elbow (not well shown in AP view, always ask for OBLIQUE view if not well seen)

•Avulsed via tension from FPO or MCL

•TLC ME

•Trochlea and lateral epicondyle fused to capitellum at 10

•Whole distal humerus fuse to metaphysis at 12

•Medial epicondyle fuse at 14

Direct Q&A

Q1 How is Paediatric medial epicondyle fracture classified here?

Watson Jones

•I <5mm displacement with no rotation

•II >5mm displacement with rotation

•III incarcerated fragment without dislocation

•IV incarcerated fragment with dislocation

Q2 What history should be elicited for Paediatric medial epicondyle fracture?

Mechanism of injury

•Chronicity of injury

•Any dislocation episode

Q3 What examination findings should be assessed in Paediatric medial epicondyle fracture?

Check ulnar nerve

•Check wound

Q4 What operative steps, indications, and risks are listed for Indication for surgery?

Absolute: incarcerated fragment

•Relative: >5mm displacement, valgus instability

•Reduction maneuvers: Roberts

•supination + valgus + wrist extension

•Fix with lag screw, K wire, absorbable pin

Q5 What anatomy is relevant to Paediatric medial epicondyle fracture?

Last ossification center to fuse

•At posteromedial aspect of elbow (not well shown in AP view, always ask for OBLIQUE view if not well seen)

•Avulsed via tension from FPO or MCL

•TLC ME

•Trochlea and lateral epicondyle fused to capitellum at 10

•Whole distal humerus fuse to metaphysis at 12

•Medial epicondyle fuse at 14

Raw speaker-note hierarchy audit

#	lvl	marL	indent	logical	original note line
1	0	None	None	0	Fracture medial epicondyle with displacement of the fragment into the UHJ
2	0	0	0	0	Associated with *elbow dislocation
3	0	0	0	0	Classification
4	0	0	0	0	Watson Jones
5	1	457200	0	1	I <5mm displacement with no rotation
6	1	457200	0	1	II >5mm displacement with rotation
7	1	457200	0	1	III incarcerated fragment without dislocation
8	1	457200	0	1	IV incarcerated fragment with dislocation
9	0	0	0	0	Hx:
10	0	0	0	0	Mechanism of injury
11	0	0	0	0	Chronicity of injury
12	0	0	0	0	Any dislocation episode
13	0	0	0	0	PE:
14	0	0	0	0	Check ulnar nerve
15	0	0	0	0	Check wound
16	0	0	0	0	Mx:
17	0	0	0	0	Indication for surgery
18	0	0	0	0	Absolute: incarcerated fragment
19	0	0	0	0	Relative: >5mm displacement, valgus instability
20	0	0	0	0	Reduction maneuvers: Roberts
21	0	0	0	0	supination + valgus + wrist extension
22	0	0	0	0	Fix with lag screw, K wire, absorbable pin
23	0	0	0	0	=======================
24	0	0	0	0	Typical age: Age 11-14
25	0	None	None	0	Mechanism
26	0	171450	-171450	1	Fall on outstretched hand
27	0	171450	-171450	1	Associated with elbow dislocation (up to 50%) – fragment may be incarcerated in the joint
28	0	171450	-171450	1	Overuse by overhead throwing athlete (little leaguer elbow)
29	0	0	0	0	Pathoanatomy
30	0	171450	-171450	1	Last ossification center to fuse
31	0	171450	-171450	1	At posteromedial aspect of elbow (not well shown in AP view, always ask for OBLIQUE view if not well seen)
32	0	171450	-171450	1	Avulsed via tension from FPO or MCL
33	0	0	0	0	TLC ME
34	0	0	0	0	Trochlea and lateral epicondyle fused to capitellum at 10
35	0	0	0	0	Whole distal humerus fuse to metaphysis at 12
36	0	0	0	0	Medial epicondyle fuse at 14

lvl

marL

indent

logical

original note line

None

Fracture medial epicondyle with displacement of the fragment into the UHJ

Associated with *elbow dislocation

Classification

Watson Jones

457200

I <5mm displacement with no rotation

457200

II >5mm displacement with rotation

457200

III incarcerated fragment without dislocation

457200

IV incarcerated fragment with dislocation

Hx:

Mechanism of injury

Chronicity of injury

Any dislocation episode

PE:

Check ulnar nerve

Check wound

Mx:

Indication for surgery

Absolute: incarcerated fragment

Relative: >5mm displacement, valgus instability

Reduction maneuvers: Roberts

supination + valgus + wrist extension

Fix with lag screw, K wire, absorbable pin

=======================

Typical age: Age 11-14

None

Mechanism

171450

-171450

Fall on outstretched hand

171450

-171450

Associated with elbow dislocation (up to 50%) – fragment may be incarcerated in the joint

171450

-171450

Overuse by overhead throwing athlete (little leaguer elbow)

Pathoanatomy

171450

-171450

Last ossification center to fuse

171450

-171450

At posteromedial aspect of elbow (not well shown in AP view, always ask for OBLIQUE view if not well seen)

171450

-171450

Avulsed via tension from FPO or MCL

TLC ME

Trochlea and lateral epicondyle fused to capitellum at 10

Whole distal humerus fuse to metaphysis at 12

Medial epicondyle fuse at 14

Improved semantic hierarchy used for the study notes

#	semantic level	section?	rewritten line
1	0		Fracture medial epicondyle with displacement of the fragment into the UHJ
2	1		Associated with *elbow dislocation
3	0	yes	Classification
4	1		Watson Jones
5	1		I <5mm displacement with no rotation
6	1		II >5mm displacement with rotation
7	1		III incarcerated fragment without dislocation
8	1		IV incarcerated fragment with dislocation
9	0	yes	History
10	1		Mechanism of injury
11	1		Chronicity of injury
12	1		Any dislocation episode
13	0	yes	Examination
14	1		Check ulnar nerve
15	1		Check wound
16	0	yes	Management
17	0	yes	Indication for surgery
18	1		Absolute: incarcerated fragment
19	1		Relative: >5mm displacement, valgus instability
20	1		Reduction maneuvers: Roberts
21	1		supination + valgus + wrist extension
22	1		Fix with lag screw, K wire, absorbable pin
23	0		——
24	1		Typical age: Age 11-14
25	1		Mechanism
26	1		Fall on outstretched hand
27	1		Associated with elbow dislocation (up to 50%) – fragment may be incarcerated in the joint
28	1		Overuse by overhead throwing athlete (little leaguer elbow)
29	0	yes	Pathoanatomy
30	1		Last ossification center to fuse
31	1		At posteromedial aspect of elbow (not well shown in AP view, always ask for OBLIQUE view if not well seen)
32	1		Avulsed via tension from FPO or MCL
33	1		TLC ME
34	1		Trochlea and lateral epicondyle fused to capitellum at 10
35	1		Whole distal humerus fuse to metaphysis at 12
36	1		Medial epicondyle fuse at 14

semantic level

section?

rewritten line

Fracture medial epicondyle with displacement of the fragment into the UHJ

Associated with *elbow dislocation

yes

Classification

Watson Jones

I <5mm displacement with no rotation

II >5mm displacement with rotation

III incarcerated fragment without dislocation

IV incarcerated fragment with dislocation

yes

History

Mechanism of injury

Chronicity of injury

Any dislocation episode

yes

Examination

Check ulnar nerve

Check wound

yes

Management

yes

Indication for surgery

Absolute: incarcerated fragment

Relative: >5mm displacement, valgus instability

Reduction maneuvers: Roberts

supination + valgus + wrist extension

Fix with lag screw, K wire, absorbable pin

——

Typical age: Age 11-14

Mechanism

Fall on outstretched hand

Associated with elbow dislocation (up to 50%) – fragment may be incarcerated in the joint

Overuse by overhead throwing athlete (little leaguer elbow)

yes

Pathoanatomy

Last ossification center to fuse

At posteromedial aspect of elbow (not well shown in AP view, always ask for OBLIQUE view if not well seen)

Avulsed via tension from FPO or MCL

TLC ME

Trochlea and lateral epicondyle fused to capitellum at 10

Whole distal humerus fuse to metaphysis at 12

Medial epicondyle fuse at 14

125. Paediatric medial epicondyle fracture

Clean FRCS notes with inline figures

Classification

History

Examination

Management

Indication for surgery

Pathoanatomy

Direct Q&A

Watson Jones

Mechanism of injury

Check ulnar nerve

Absolute: incarcerated fragment

Last ossification center to fuse

Raw speaker-note hierarchy audit

Improved semantic hierarchy used for the study notes