An elbow dislocation in a child with missed medial epicondyle fracture and late ulnar nerve palsy

Abstract

Elbow dislocations associated with a medial epicondyle fracture and ulnar nerve palsy are uncommon injuries. We present the case of an 11-year-old girl with an elbow dislocation treated by closed manual reduction. The medial epicondyle fracture was missed initially until she developed an ulnar nerve palsy 2 months later. Intraoperatively we discovered the bony epicondyle piercing the joint capsule and compressing the ulnar nerve. Removal of the bony fragment relieved her symptoms and she returned to normal activities at 1 year follow-up. We would like to highlight this rare occurrence and present the detailed history and management of this case.

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

“… 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.…”

Intra-articular Entrapment of Medial Epicondyle Fracture Fragment in Elbow Joint Dislocation Causing Ulnar Neuropraxia: A Case Report

“…Medial humerus epicondyle fracture is the most common associated injury in complex paediatric elbow dislocation 1 . Intra-articular entrapment of the fracture fragment in the elbow joint occurs in 5-18% of cases 2 but ulnar neuropraxia is rare 1,3,4 . In children, the medial collateral ligament is intact during elbow dislocation contributing to medial humerus epicondyle fracture 2 .…”

“…However, screw prominence can cause irritation and interference with bone growth, thus implant removal is required at a later stage 2 . Fowles et al recommended anterior ulnar nerve transposition in patients with signs of ulnar nerve compression 3 . However, a study by Chen et al showed that ulnar nerve transposition could increase the risk of ulnar neuritis 5 .…”

“…Most paediatric elbow dislocations are complex dislocations and medial humerus epicondyle avulsion fracture is the most common associated injury 1 . In medial humerus epicondyle fracture, intra-articular entrapment of fracture fragment in the elbow joint occurs in 5-18% of cases 2 but ulnar neuropraxia is very rare 1,3,4 . Treatment of such injury involves closed manipulative reduction of the elbow dislocation and open reduction and internal fixation of the fracture using various techniques which include screw fixation, Kirschner wiring, sutures or excision of the fracture fragment 2 .…”

“…Treatment of such injury involves closed manipulative reduction of the elbow dislocation and open reduction and internal fixation of the fracture using various techniques which include screw fixation, Kirschner wiring, sutures or excision of the fracture fragment 2 . However, ulnar nerve transposition is still debatable 3-5 .…”