Incarcerated medial epicondyle fracture following pediatric elbow dislocation: 11 cases

J Hand Surg Am. 2014 Sep;39(9):1739-45. doi: 10.1016/j.jhsa.2014.06.012. Epub 2014 Jul 16.

Abstract

Purpose: To describe outcomes after surgical management of pediatric elbow dislocation with incarceration of the medial epicondyle.

Methods: We conducted a retrospective case review of 11 consecutive children and adolescents with an incarcerated medial epicondyle fracture after elbow dislocation. All patients underwent open reduction internal fixation using a similar technique. We characterized outcomes at final follow-up.

Results: Average follow-up was 14 months (range, 4-56 mo). All patients had clinical and radiographic signs of healing at final follow-up. There was no radiographic evidence of loss of reduction at intervals or at final follow-up. There were no cases of residual deformity or valgus instability. Average final arc of elbow motion was 4° to 140°. All patients had forearm rotation from 90° supination to 90° pronation. Average Mayo elbow score was 99.5. Four of 11 patients had ulnar nerve symptoms postoperatively and 1 required a second operation for ulnar nerve symptoms. In addition, 1 required a second operation for flexion contracture release with excision of heterotopic ossification. Three patients had ulnar nerve symptoms at final follow-up. Two of these had mild paresthesia only and 1 had both mild paresthesia and weakness.

Conclusions: Our results suggest that open reduction internal fixation of incarcerated medial epicondyle fractures after elbow dislocation leads to satisfactory motion and function; however, the injury carries a high risk for complications, particularly ulnar neuropathy.

Type of study/level of evidence: Therapeutic IV.

Keywords: Incarcerated medial epicondyle fracture; elbow dislocation; open reduction internal fixation; pediatric.

MeSH terms

  • Adolescent
  • Child
  • Elbow Injuries*
  • Elbow Joint / diagnostic imaging
  • Elbow Joint / surgery*
  • Female
  • Fracture Fixation, Internal / methods*
  • Humans
  • Humeral Fractures / diagnostic imaging
  • Humeral Fractures / surgery*
  • Joint Dislocations / diagnostic imaging
  • Joint Dislocations / surgery*
  • Male
  • Radiography
  • Treatment Outcome
  • Ulna Fractures / diagnostic imaging
  • Ulna Fractures / surgery*