Not a true physeal injury; medial epicondyle is an apophysis and does not contribute to humeral length...this is not a true Salter-Harris injury

Peak age 9-12 years
Acounts for 13% of all distal humerus fractures in children
50% are associated with elbow dislocations
Mechanism of injury: valgus force on elbow joint

Apophyseal fragment displaces distally, becoming incarcerated in the elbow joint ~18% of time
Most important step in management is ruling out concomittant injury

Gross instability: possible elbow dislocation
Fat pad sign on x-ray: possible medial condyle fracture / intrarticular pathology
Severe swelling, be wary of compartment syndrome
Treatment:
Operative Indications
1. Open fracture
2. Irreducible incarceration of fragment in elbow joint
No consensus exists in the literature in terms of acceptable amount of displacement

Nonoperative Treatment
Reduction maneuver: Valgus stress with wrist extension
Long arm cast

Jossefson et al Acta Orthop Scand 1986; 56 displaced straight forward med epi fx's tx'd non-op displacment ranged 1-15mm: "very good function and ROM expected" long term with immobilization alone

Wilson et al Injury 1988; 20 non-op 23 op treatment: operative treatment had better radiographic reduction, higher union rate, BUT higher rate of minor symptoms (ulnar neuropathy, pain decreased ROM)

Operative Treatment
CRPP vs. cannulated lag screw