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The fragment displaces anteromedially. Anteroposterior (AP) radiographs are most accurate to determine displacement.
4%
124/2780
The fragment displaces posteromedially. Internal oblique (IR) radiographs are most accurate to determine displacement.
17%
463/2780
The fragment displaces anteriomedially. Distal humeral axial radiographs are most accurate to determine displacement.
46%
1266/2780
The fragment displaces posteromedially. Distal humeral radiographs are most accurate to determine displacement.
114/2780
The fragment displaces anteromedially. IR radiographs are most accurate to determine displacement.
28%
777/2780
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The medial epicondyle fragment displaces anteriorly. Distal humeral axial radiographs are most accurate to determine displacement. Pediatric medial epicondyle fractures make up 12% of elbow fractures (3rd most common elbow fracture) and mostly occur in 11-12 year old patients. The medial epicondyle displaces ANTERIORLY because of the flexor-pronator attachment. The assessment and treatment of this injury is controversial. Absolute indications for surgery include incarcerated fragment and open fracture. Relative indications include gross instability and ulnar nerve entrapment. Recommendations for surgery based on displacement range from 2 to 15mm. Edmonds compared the use of radiographs to 3D CT for determining displacement. Lateral radiographs UNDERestimated anterior displacement. AP radiographs OVERestimate medial displacement. IR radiographs best matched 3D CT results compared to AP radiographs. They concluded that AP and lateral radiographs are insufficient, IR radiographs are more accurate, but 3D CT is the most accurate. Souder, Edmonds and others. further expanded the evaluation of fracture displacement using a cadaveric model, adding a new radiographic technique "distal humeral axial radiographs". They found that AP, lateral and IR views UNDERestimated displacement. The fragment was not visualized on lateral views except in 1 with displacement >10mm, which was overestimated. Fragments were not seen on the lateral view if displacement <10mm. Axial radiographs substantially improved displacement measurement and most closely estimated the true amount of displacement. Illustration A shows x-ray positioning to obtain the distal humeral axial view (25deg anterior to the long axis of the humerus). Illustration B shows the appearance of a medial epicondyle fracture under different radiographic views. Illustration C shows the appearance of a medial epicondyle fracture on lateral x-ray and 3D CT. Incorrect Answers: Answers 1 and 5: Axial radiographs are most accurate for determining displacement. Answers 2 and 4: The fragment displaces anteriorly.
2.1
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