Intra-Articular Medial Epicondyle Avulsion Fracture Entrapment Following Closed Reduction Attempt of Posterior Elbow Dislocation

Abstract

Introduction: Pediatric complex elbow dislocations are uncommon injuries as intraarticular medial epicondyle fracture incarceration associated with posterior elbow dislocation occurs in 5-18% of all cases. A high-index of suspicion necessitates a computed tomography (CT) evaluation of the elbow joint as conventional two-plain radiography can be falsely interpreted as normal. The proposed treatment for this type of injury is surgical with multiple techniques being described in the literature.Case report: A fifteen-year-old male presented to our emergency department with left elbow pain, medial elbow region bruising, valgus deformity and decreased range of motion (ROM) of the affected elbow seven hours post-injury. Unsuccessfully closed reduction maneuver at the local hospital with persistent symptoms was followed by CT of the elbow joint with consequent patient transfer to our institution where another closed reduction under appropriate analgesia failed. Urgent open reduction and internal fixation (ORIF) with two second generation 3.5x30 mm fully threaded headless compression screws of the medial epicondyle fracture incarceration was done. The patient was followed-up for three months resulting in laudable patient satisfaction as a result of the painless full range of motion in everyday and sport activities. Conclusion:The imperative in diagnosing this type of injuries in pediatric posterior elbow dislocations following closed reduction attempt is to be aware of its existence. A highindex of suspicion should be further evaluated by CT. ORIF with second generation headless compression screws (HCS) fixation provides a satisfactory functional outcome.