A rare case of elbow dislocation associated with unrecognized fracture of medial epicondyle and delayed ulnar neuropathy in pediatric age

Lima, Sara; Correia, João Freitas; Ribeiro, Rui; Martins, Rui Moura; Alegrete, Nuno; Coutinho, Jorge; Costa, Gilberto Melo

doi:10.1016/j.jse.2012.11.009

Cited by 26 publications

(26 citation statements)

References 12 publications

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“…Dislocations of the elbow have been reported as often accompanied by disruption of multiple stabilisers, and thus the patho-physiology is complicated [15]. Traumatic elbow dislocation is uncommon in skeletally immature patients and generally diagnosed with concomitant fractures, avulsions or neurovascular injuries around the joint [1,5,6,[12][13][14][15][16][17][18][19]. Acute traumatic pure elbow dislocation in childhood is even more uncommon.…”

Section: Discussionmentioning

confidence: 99%

Pure elbow dislocation in the paediatric age group

Sofu

Gürsu²,

Çamurcu

et al. 2015

International Orthopaedics (SICOT)

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Section: Discussionmentioning

confidence: 99%

Pure elbow dislocation in the paediatric age group

Sofu

Gürsu²,

Çamurcu

et al. 2015

International Orthopaedics (SICOT)

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“… 4) Nevertheless, late presenting medial epicondyle fractures in association with preoperative ulnar nerve affection is extremely rare. 5 6) The outcome and complications of such an injury pattern have been reported only twice in the English literature. 5 6) The sophisticated developmental anatomy of the pediatric elbow may lead to misinterpretation of radiographs in the phase of acute trauma.…”

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confidence: 99%

A Neglected Markedly Displaced Medial Epicondyle Fracture with Simultaneous Ulnar Nerve Palsy in an Adolescent

et al. 2017

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Humeral medial epicondyle fractures constitute around 15% of pediatric elbow fractures. Up to 60% occur in association with elbow dislocations. Knowledge of potential imaging pitfalls when examining acute elbow fractures in children contributes significantly to accurate diagnosis. Nevertheless, management of missed pediatric medial epicondyle fractures has rarely been reported. We present an 11-year-old boy with a neglected and severely displaced medial epicondyle fracture with concurrent ulnar nerve palsy. We performed neural decompression, fragment excision, and muscular and capsuloligamentous reconstruction of the medial elbow. This study demonstrates that the surgical outcome of a late presenting fracture can be satisfactory in terms of function and neural recovery. It also underscores the importance of careful interpretation of elbow imaging including normal anatomic variants.

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“…Treatment of medial epicondyle fractures is controversial. However, open reduction with internal fixation of the epicondyle fragment is clearly indicated in cases of intra-articular entrapment of the fragment, on suspicion of entrapment of the ulnar nerve, or in cases of marked instability of the elbow [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…A medial epicondyle fracture associated with elbow dislocation, in children, may not be easily diagnosed on conventional radiographs because of the small size of the fragment, its ‘hidden’ position behind the distal humerus and the fact that it can be mistaken for the trochlear ossification centre [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Paediatric medial epicondyle fracture without elbow dislocation associated with intra-articular ulnar nerve entrapment

2015

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Elbow fractures are not uncommon in children, and some are associated with neurovascular injuries. Having a nerve injury in an elbow fracture without dislocation is rare and was not described in the literature. Here, we have reported probably the first case of an ulnar nerve injury in an elbow fracture without dislocation. A 9-year-old female presented to the emergency department after falling off a monkey bar. She had a painful, swollen and tender right elbow with no history or clinical signs of an elbow dislocation but had complete ulnar nerve palsy. She was managed initially with analgesia and plaster application and was taken directly to the operating theatre. Examination under anaesthesia revealed no elbow joint instability. The ulnar nerve was found entrapped between the trochlea and proximal ulna, intra-articularly. The medial epicondyle was also found avulsed from the humerus, with an incarcerated medial epicondylar fragment in the elbow joint.

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A rare case of elbow dislocation associated with unrecognized fracture of medial epicondyle and delayed ulnar neuropathy in pediatric age

Cited by 26 publications

References 12 publications

Pure elbow dislocation in the paediatric age group

Pure elbow dislocation in the paediatric age group

A Neglected Markedly Displaced Medial Epicondyle Fracture with Simultaneous Ulnar Nerve Palsy in an Adolescent

Paediatric medial epicondyle fracture without elbow dislocation associated with intra-articular ulnar nerve entrapment

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