Elbow dislocation with avulsion of the medial humeral epicondyle

Abstract

After dislocation of the elbow with avulsion of the medial epicondyle, the management of the latter is controversial. Of 28 children followed up after initial closed reduction of the elbow, 19 had a satisfactory closed reduction of the epicondyle and were treated in plaster. At follow-up, 11 children had a normal elbow and eight had lost an average of 15 degrees of flexion. Nine children had had open reduction and internal fixation of the fragment, one for an open injury, three for displacement of the epicondyle and six for intra-articular entrapment of the fragment. Five of these children had ulnar nerve contusion or compression, four requiring anterior transposition of the nerve. At review, only three had normal elbows and six had lost an average of 37 degrees of flexion. We agree with other authors that surgery is indicated only for children in whom the epicondyle is trapped in the joint or is significantly displaced after closed reduction.

Osteosynthesis of medial humeral epicondyle fractures in children: 8-year follow-up of 33 cases

“…On the contrary, non-operative treatment has been recommended by authors who found good function and range of motion of the elbow, in spite of a high frequency of pseudoarthrosis, and surgery was consequently only recommended in cases where the fragment was intraarticularly entrapped (Wilson 1960, Fowles et al 1990, Wilson et al 1988.…”

Clinical Results of Surgically Treated Medial Humeral Epicondylar Apophyseal Avulsion Injury in Children and Adolescent.

“…Thirteen (65%) were boys and 7 (35%) were girls. Average age of children was 10.8 years (SD=2.3, range [8][9][10][11][12][13][14][15][16]. Twelve (60%) fractures were associated with an elbow dislocation out of which five cases reduced spontaneously jlmc.edu.np and remaining 15 elbows were reduced either in Emergency Department or in operating room.…”

“…The consistent good results were achieved by operated fixation as reported by Hines et al, Lee et al and Fowles et al along with our own series would advocate surgical intervention when there is a displacement. 1,4,16 Operative management allows for anatomic reduction internal fixation of the fragment and incase of incarceration, removal Pro**** -Pronation of the offending fragment under direct visualization followed by stabilization. Surgical reduction and fixation of medial epicondyle along with its strong flexor pronator muscle origin and medial collateral ligament may contribute to critical restraint against valgus instability and allow for early elbow movements.…”

Kırık Fragmanı Eklem İçinde Olan Medial Epikondil Kırığıyla Birlikte İhmal Edilmiş Pediatrik Dirsek Çıkığı: Olgu Sunumu

“…Buna rağmen manipülasyon denenirse eklem yüzeyi hasarı veya kemik kırığı oluşabilir. Çoğu otorite 3 aya kadar dirsek redüksiyonu için açık redüksiyon önermektedir (3,4). Günlük hayattaki çoğu aktivite 1000 fleksiyon arkı ve 1000 supinasyon -pronasyon arkı ile yapılabilmektedir.…”