The medial epicondyle apophysis is a secondary ossification centre that fuses to the medial humeral metaphysis between 15-20 years. In children, this apophysis is subject to avulsion, creating an apophyseal fracture space that must be distinguished from normal unfused apophysis on X-ray.
Medial epicondyle avulsion in children occurs from acute valgus elbow injury or from the chronic repetitive valgus stress of little league elbow. The apophysis may be trapped in the joint (incarcerated) following elbow dislocation, requiring urgent open reduction. The apophyseal ossification centre appears at 5-7 years — before this age the medial epicondyle cannot be avulsed.
Acute avulsion of the medial epicondyle apophysis from valgus injury or elbow dislocation producing medial elbow pain and tenderness in a child or adolescent, requiring surgical fixation when displaced or incarcerated in the joint.
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