The trochlea is the spool-shaped medial articular surface of the distal humerus that articulates with the trochlear notch of the ulna, forming the humeroulnar hinge joint. The central groove of the trochlea fits precisely into the ridge of the ulna's coronoid and olecranon, providing the inherent bony stability of the elbow that makes it one of the most congruous joints in the body. The medial epicondyle is the origin of the UCL just posterior to the trochlea.
Lateral condyle fractures in children involving the capitellum and lateral portion of the trochlea (Milch classification) are the most common paediatric elbow fracture requiring surgical fixation. Unlike supracondylar fractures they are intra-articular and produce a Salter-Harris IV growth plate injury with risk of physeal damage and malunion if inadequately reduced. The trochlea develops from multiple ossification centres (the last to appear in the CRITOE sequence) which can appear fragmented and be confused with fractures.
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