Pediatric medial epicondyle fractures with intra-articular elbow incarceration

Abstract

BackgroundIntra-articular incarceration of the epicondylar fragment occurs in 5–18 % of all cases of medial epicondyle fracture. It requires stable fixation to allow early motion, since elbow stiffness is the most common complication following medial epicondyle fracture. In this retrospective study, we report the clinical and functional outcomes and the complications that occurred following open reduction and screw fixation of medial epicondyle fractures with intra-articular fragment incarceration.MethodsThirteen children who had a fracture of the medial epicondyle with incarceration of the fragment in the elbow joint (type III) were surgically treated in our university hospital between 1998 and 2012. There were eight male and five female patients. The mean age at the time of injury was 13 years (range 9–16). Operative treatment consisted of open reduction and internal fixation with one or two 4.0-mm cannulated screws under fluoroscopic control.ResultsAll of the patients were clinically reviewed at an average follow-up of 29 months. The overall range of motion limitation was about 5° for flexion–extension and 2° for pronation–supination. The score was excellent in all patients (mean 96.3). Complications occurred in four (31 %) children: two cases of symptomatic screw head prominence, irritation with partial lesion of the distal triceps myotendinous junction in one patient, and median nerve entrapment syndrome in one patient.ConclusionsIn conclusion, open reduction and screw fixation yielded excellent clinical and functional outcomes for the treatment of medial epicondyle fractures with intra-articular fragment incarceration. However, particular attention is should be paid when treating these potentially serious injuries in order to minimize the risk of possible complications.Level of evidenceTherapeutic IV.

Pure elbow dislocation in the paediatric age group

“…In their study evaluating the clinical results of 33 elbow dislocations including 30 % pure dislocations in childhood, Frongia et al [9] reported good to excellent results for all children. Excellent results were also demonstrated in patients with posterolateral dislocation associated with medial epicondyle fracture [12]. In our study, according to MEPS score, the clinical outcome was excellent in nine patients, good in two and fair in one.…”

“…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.…”

“…Medial epicondyle avulsion has been reported as the most commonly encountered concomitant injury [1,3,7]. Only a limited number of pure elbow dislocations in the paediatric age group have been reported in the literature [1,4,[7][8][9][10][11][12]. Restoration of stability remains the mainstay of treatment [6].…”

Medial epicondyle fractures in children

“…Options for fixation include sutures, Kirschner wires (K-wires), cannulated screws, and excision of the fragment with advancement of the medial soft tissues [ [34][35][36][37] suggest the use of K-wires in younger children and cannulated screws in older children. Sutures are typically used only for very small or comminuted fragments.…”

“…Several authors [8 & ,19,35] report excellent Mayo Elbow Performance Scores, no deformity or valgus instability, and an average loss of 4-6.4 degrees of extension following open reduction and internal fixation of medial epicondyle fractures associated with incarceration, dislocation, or both. Furthermore, these patients can be expected to return to sports, an average 4 months postoperatively, at their preinjury level [35].…”