History of medial epicondylar fracture status post ORIF now with a flexion contracture. Evaluate soft tissue contracture versus mechanical block. As seen on the recent radiographs, there is medial epicondyle bone fragment situated in near-anatomic alignment along the medial aspect of the distal humerus. The gap between the fragment and the underlying bone is approximately 1 mm. There is no bony bridging between the fragment and the underlying humerus. The fragment is of relatively low signal intensity on T1 weighted images as well as mildly increased signal intensity on T2 weighted images and appears slightly sclerotic on radiographs; these findings may reflect at least some necrosis of the fragment. Mild edema within the underlying medial condyle is noted.The anterior bundle of the ulnar collateral ligament attaches to the fragment and the coronoid process of the ulna in normal fashion. The proximal fibers of the common flexor tendon appeared to attach to both the fragment and humerus with minimal intrasubstance signal perhaps represent mild tendinosis. The lateral supporting structures of the elbow appear intact.The biceps and brachioradialis muscles and tendons are normal. The triceps appears normal. The musculature is within normal limits.The ulnar nerve lies along the posterolateral aspect of the aforementioned medial epicondyle fracture fragment which may represent posttraumatic subluxation. The remaining soft tissue structures are normal. A small amount of fluid is noted in the elbow joint, but no large effusion or loose bodies are seen.
Medial epicondyle fracture fragment in near anatomic alignment as described above without evidence of bony union. Low signal intensity in the fragment on T1 weighted images may reflect at least partial necrosis of the fragment. The ulnar collateral ligament attaches to this fragment but appears normal, and we otherwise see no specific findings to account for the patient's flexion contracture.