A Blocking Barrier During Reduction of the Elbow Dislocation in Children: Incarcerated Medial Epicondyle Fracture

Year 2018, Volume: 4 Issue: 2, 103 - 107, 01.04.2018

Guzelali Ozdemir Alper Deveci , Olgun Bingol Enver Kilic Erman Ceyhan Sualp Turan

https://doi.org/10.5455/umj.20171107113200

Abstract

Background: In children, an incarcerated medial epicondyle fracture of the distal humerus associated with elbow dislocation, may be missed on conventional radiographs. Other reliable radiological criteria are imperative for the diagnosis of these fractures. The purpose of the study was to investigate the clinical results of the operative treatment of incarcerated medial epicondyle fractures after elbow dislocation in children and define new radiological criteria in the diagnosis. Materials and Methods: A sea wave-like shaped parallel double line was seen on anterior-posterior elbow radiographs of non-fractured pediatric patients. The disruption of the sea wave-like sign was defined as a new diagnostic radiographic criterion in incarcerated medial epicondyle fractures after elbow dislocation in children. Seven children with an incarcerated medial epicondyle fracture. Results: The mean age was 12.14±2.1 years range: 9-15 years and the mean follow-up period was 29.1±13.6 months range: 12-48 months . The mean Mayo elbow score was 92.8±4.8 range: 85-100 at the final follow-up. The new diagnostic radiological criterion was identified in all incarcerated medial epicondyle fractured patients. Conclusions: The results of this study suggest that open reduction internal fixation of incarcerated medial epicondyle fractures after elbow dislocation resulted in satisfactory motion and function. The new diagnostic radiological criterion defined in this study is useful, does not incur any additional cost and may solve the diagnostic problems of incarcerated medial epicondyle fractures of the distal humerus after elbow dislocation in the pediatric population.

Keywords

Medial epicondyle fracture, incarcerated, radiologic

References

• 1. Gottschalk HP, Eisner E, Hosalkar HS. Medial epicondyle fractures in the pediatric population. J Am Acad Orthop Surg 2012;20:223–32.
• 2. Kobayashi Y, Oka Y, Ikeda M, Munesada S. Avulsion fracture of the medial and lateral epicondyles of the humerus. J Shoulder Elbow Surg 2000;9(1):59-64.
• 3. Fowles JV, Slimane N, Kassab MT. Elbow dislocation with avulsion of the medial humeral epicondyle. J Bone Joint Surg Br 1990;72(1):102-4.
• 4. Farsetti P, Potenza V, Caterini R, Ippolito E. Long-term results of treatment of fractures of the medial humeral epicondyle in children. J Bone Joint Surg Am 2001;83(9):1299-305.
• 5. Wilson NI, Ingram R, Rymaszewski L, Miller JH. Treatment of fractures of the medial epicondyle of the humerus. Injury 1988;19(5):342-4.
• 6. Beaty JH, Kasser JR (2010) The elbow: physeal fractures, apophyseal injuries of the distal humerus, osteonecrosis of the trochlea, and T-condylar fractures. In: Beaty JH, Kasser JR (eds) Rockwood and Wilkins’ fractures in children, 7th ed. Lippincott Williams & Wilkins, Philadelphia, pp 566–77.
• 7. Smith BG, Pierz KA (2011) Open reduction and internal fixation of fractures of the medial epicondyle. In: Flynn JM, Wiesel SW (eds) Operative techniques in orthopedic surgery, vol:2. Lippincott Williams&Wilkins, Philadelphia, pp 1042–5.
• 8. Lindham S, Hugosson C. The significance of associated lesions including dislocation in fractures of the neck of the radius in children. Acta Orthop Scand 1979;50(1):79-83.
• 9. Lee HH, Shen HC, Chang JH, Lee CH, Wu SS. Operative treatment of displaced medial epicondyle fractures in children and adolescents. J Shoulder Elbow Surg 2005;14 (2):178-85.
• 10. Lima S, Correia JF, Ribeiro RP, Martins RM, Alegrete N, Coutinho J, Costa GM. A rare case of elbow dislocation associated with unrecognized fracture of medial epicondyle and delayed ulnar neuropathy in pediatric age. J Shoulder Elbow Surg 2013;22(3):e9–e11.
• 11. Kamath AF, Baldwin K, Horneff J, Hosalkar HS. Operative versus nonoperative management of pediatric medial epicondyle fractures: A systematic review. J Child Orthop 2009;3(5):345-57.
• 12. Ip D, Tsang WL. Medial humeral epicondylar fracture in children and adolescents. J Orthop Surg (Hong Kong) 2007;15(2):170-3.
• 13.Hines RF, Herndon WA, Evans JP. Operative treatment of medial epicondyle fractures in children. Clin Orthop Relat Res 1987;223:170-4.
• 14.Gilchrist AD, McKee MD. Valgus instability of the elbow due to medial epicondyle nonunion: Treatment by fragment excision and ligament repair. A report of 5 cases. J Shoulder Elbow Surg 2002;11(5):493-7.
• 15. Skak SV, Grossmann E, Wagn P. Deformity after internal fixation of fracture separation of the medial epicondyle of the humerus. J Bone Joint Surg Br 1994;76(2):297-302.
• 16.Haflah NHM, Ibrahim S, Sapuan J, Abdullah S. An elbow dislocationin a child with missed medial epicondyle fracture and late ulnar nerve palsy. J Pediatr Orthop B 2010;19:459- 61.
• 17. Rasool MN. Dislocation of the elbow in children. J Bone Joint Surg Br 2004;86-B:1050-8.
• 18. Patrick J. Fracture of the medial epicondyle with displacement into the elbow joint. J Bone Joint Surg 1946;28:143-7.
• 19. Martini M, Hallaj N, Daoud A, Descamps L. Les luxations traumatiques recentes du coude: a propos de 94 observations. Acta Orthop Belg 1978;44:542-54.