Korean J Sports Med.  2013 Dec;31(2):115-119. 10.5763/kjsm.2013.31.2.115.

Intra-Apophyseal Avulsion Fracture of Medial Epicondyle in a Adolescent Baseball Player

• Kim TK
• Park JT
• Cho HL
• Jin HK

• KMID: 2288617
• DOI: http://doi.org/10.5763/kjsm.2013.31.2.115

Abstract

Overuse elbow injuries in young throwing athletes are generally defined as 'Little Leaguer's elbow'. Repetitive submaximal valgus forces on the medial epicondylar apophysis in such athletes can result in apophyseal separation or chronic apophyseal fragmentation, which would usually take over more than a year to heal. We report of a unique case of a 13-year-old male baseball pitcher who, due to the traction of the medial collateral ligament, presented with an acute intra-apophyseal avulsion fracture of the medial epicondyle. The fracture was successfully healed using a long arm cast, and correct union was confirmed by 3 dimensional computed tomography at 8 weeks post-trauma. This acute avulsion fracture is a variant of Little Leaguer's elbow and should be distinguished in terms of diagnosis and treatment from common lesion such as chronic fragmentation of the medial epicondylar apophysis.

Keyword

Intra-apophyseal avulsion fracture; Little leaguer's elbow; Medial epicondylar fragmentation

MeSH Terms

Adolescent*
Arm
Athletes
Baseball*
Collateral Ligaments
Diagnosis
Elbow
Humans
Male
Traction

Figure

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  Fig. 1. Anteroposterior radiographs of the both elbow show evidence of an avulsion fracture (white arrow) of the inferior portion of the left medial epicondylar apophysis.

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  Fig. 2. (A, B) Initial computed tomography and 3 dimensional reconstruction images show displaced avulsion fracture (white arrow head) and (C) coronal T2-weighted magnetic resonance image shows a intraapophyseal fracture gap (white arrow head) and minimal bone marrow edema and the anterior bundle of medial collateral ligament is attached to the bony fragment (white arrow).

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  Fig. 3. (A– D) Serial anteroposterior radiographs of the left elbow with 2 weeks interval shows progression of the union with callus.

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  Fig. 4. (A, B) Computed tomography and 3 dimensional reconstruction images at 8 weeks after the trauma reveal union of the fracture site and (C) final follow-up anteroposterior radiograph shows nearly normal appearance of medial epicondylar apophysis with bony remodeling.

Reference

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