FIGURE 111.20 Lateral condylar fracture in a 2-year-old girl (arrow ) Fractures of the medial epicondyle occur as the result of direct elbow trauma or when the elbow is subjected to a valgus stress during a fall or vigorous throwing The medial epicondyle of the humerus is an apophysis that is the point of attachment for the forearm flexor muscles, the pronator teres, and the medial collateral ligament As with lateral epicondyle fractures, this tends to be an avulsion injury that may be difficult to diagnose prior to ossification of the