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

Abstract

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.

Iatrogenic nerve injuries following surgery for paediatric distal humeral epiphyseal fractures – a report of 2 cases

“…We found only single reports in literature. Non-or malunion resulting in functional dysfunction, restriction of range of motion and valgus attitude of the elbow are more frequently described [1,2,3]. Both of the nerve injuries reported in this study were iatrogenic and occurred at operative treatment of distal humerus fractures.…”

“…We found several reports in literature presenting ulnar nerve injuries associated with elbow dislocation and fracture of the medial epicondyle in 10-12-year-old boys [1,2,3,4,5,6,7,8,9]. In most of these cases, epicondylar fracture was initially not diagnosed, resulting in its displacement and compression of the ulnar nerve.…”

Image Fusion of X-ray and Magnetic Resonance Imaging-Based Evaluation of the Stability of Pediatric Lateral Humeral Condyle Fracture

“…Lateral humeral condyle fractures are mostly fractures are the second most common intra-articular fracture after supracondylar fractures of the humerus. It easily occurs in children around 6 years old (1). The accurate judgment of the degree of fracture displacement is of great significance for clinical classification and treatment selection.…”

“…It refers to the joint fracture of the humeral lateral condyle with the capitulum of the humerus or the external lateral condyle of the humerus and the partial epiphysis of the trochlear bone, accounting for 12%-20% of pediatric elbow fractures. The incidence of pediatric fractures is second only to supracondylar fractures of the humerus, commonly occurring in children between 5-12 years old (1). Children with lateral humeral fractures often show lateral swelling which gradually spread to the entire joint with ecchymosis and elbow cubitus malformation which involves various mechanisms.…”

A missed medial humeral epicondyle fracture with incarcerated fragment in the elbow joint and ulnar nerve palsy: A rare case report

“…Medial epicondyle fractures are mostly treated conservatively, but surgery is indicated in special circumstances such as intra‐articular incarcerated fragment, ulnar nerve palsy, open fracture, or significant instability. However, there is controversy in the literature regarding the outcome of delayed construction of missed medial epicondyle fracture with entrapped intra‐articular fracture fragment 3‐5 …”