epicondyle (4 to years old), but this injury is not typically intra-articular ( Fig 111.21 ) Clinically, children often present with the elbow held in flexion and with swelling and tenderness localized to the medial aspect of the elbow, with valgus instability (most readily demonstrated by stress radiographs) Oblique radiograph views in addition to stress and comparison views may be needed for diagnosis Additional imaging with MRI examination may prove useful in defining the extent of the injury Nondisplaced fractures are managed in the emergency setting with casting or posterior splinting with the elbow in flexion and neutral position, or pronation for weeks with outpatient orthopedic follow-up Indications for surgical management are widely debated and evidence is limited except for cases of incarcerated fracture fragment within the joint Orthopedic consultation is advised in patients with neuropathy, valgus instability, or fracture fragment displacement >2 mm