Posteromedial elbow dislocation with lateral humeral condylar fracture in children

Abstract

Rationale:Posteromedial dislocations of the elbow with lateral humeral condylar fractures (LCFs) are uncommon, and only isolated cases have been reported in the English-language literature. Because of the complex radiolucent cartilaginous structures and late-appearing ossification centers, radiological diagnosis of elbow dislocations with LCF in children is challenging.Patient Concerns:We report three children with posteromedial elbow dislocation: two patients with Milch type I and one patient with Milch type II LCF.Diagnoses:In our report, radiographs showed only a small bone fragment, and arthrography or computed tomography were helpful diagnostic aids in cases 1 and 3. In contrast, the patient in case 2 was initially misdiagnosed as having an epiphyseal separation of the distal humerus, and open reduction and internal fixation through the posterior approach revealed Milch type II LCF.Interventions:In case 1 and 3, Milch type I LCFs, open reduction and internal fixation was performed through the posterolateral approach. On the other hand, in case 2, Milch type II LCF, open reduction and internal fixation was performed through the posterior approach.Outcomes:Poor reduction of Milch type I LCFs resulted in incongruity of the articular surface and poor cosmetic results in two patients. In case 2, Milch type II LCF, plain radiographs showed adequate healing without elbow deformity and the clinical result was excellent.Lessons:Because LCFs are intra-articular fractures, anatomical reduction is crucial for satisfactory outcomes. We promote awareness of this injury, especially posteromedial dislocation with Milch type I LCF. Preoperative evaluation is helpful for achieving satisfactory outcomes, and open reduction and internal fixation through an anterolateral approach might be most appropriate for Milch type I LCFs.

Lesión compleja del codo pediátrico: fractura de cóndilo externo asociada a luxación posteromedial de codo.

“…El diagnóstico temprano de estas lesiones, así como su tratamiento precoz es fundamental para el buen pronóstico de las mismas 3,4,9,10 . Según la literatura y nuestra propia experiencia, el método recomendado es una reducción cerrada de la luxación y una posterior reducción abierta y osteosíntesis de la fractura del cóndilo externo 3,4,7,8,9 .…”

“…El codo es una de las articulaciones que más lesiones sufre durante la infancia. Las luxaciones de codo y las fracturas de cóndilo lateral son lesiones relativamente frecuentes en el codo pediátrico [1][2][3][4][5][6][7][8][9][10] . No obstante, la luxación posteromedial de codo asociada a una fractura de cóndilo externo del húmero es una lesión rara en la edad pediátrica, y de difícil diagnóstico inicial, debido a los múltiples núcleos de osificación que presenta el codo en la infancia [3][4][5][6][7][8] .…”

“…No obstante, la luxación posteromedial de codo asociada a una fractura de cóndilo externo del húmero es una lesión rara en la edad pediátrica, y de difícil diagnóstico inicial, debido a los múltiples núcleos de osificación que presenta el codo en la infancia [3][4][5][6][7][8] . De hecho, no existe literatura en español sobre estas lesiones, y los casos publicados en lengua inglesa son escasos 3,5,10 . Generalmente, esta fractura se produce debido a una caída sobre la mano con semiflexión del codo, en posición de varo forzado 3,4,7,8,9 .…”

Concomitant Posteromedial Elbow Dislocation with Lateral Condyle Humerus Fracture in a 7 Years Old – A Rare Case Report and Review of the Literature

“…Cheng et al [ 5 ] reported three cases with elbow dislocation associated with LCF and observed suboptimal range of motion in two cases, the authors observed that poor functional range of motion is inevitable in case of unsatisfactory anatomical reduction by either open or closed reduction and if the joint is incongruent. Tomori et al [ 13 ] emphasized to increase awareness of these injuries for achieving satisfactory outcomes. Silva et al [ 14 ] reported that satisfactory outcomes can be expected if prompt reduction and anatomical reduction is achieved in his case series of 12 cases with a mean follow-up of 51 weeks.…”

One additional shot of brachial plexus block equates to less postoperative pain for younger children with elbow surgeries

“…In displaced LCFH and MCFH, open reduction and internal fixation (ORIF) is our preferred choice and usually yields satisfactory outcomes [27,28]. Whereas, closed reduction and percutaneous pinning (CRPP) remains the primary choice for displaced SCFH [29].…”