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A rare case of elbow dislocation associated with unrecognized fracture of medial epicondyle and delayed ulnar neuropathy in pediatric age

2013; Elsevier BV; Volume: 22; Issue: 3 Linguagem: Inglês

10.1016/j.jse.2012.11.009

1532-6500

Sara Lima, João Correia, Rui Ribeiro, Rui Moura Martins, Nuno Alegrete, Jorge Coutinho, Gilberto Melo Costa,

Orthopedic Surgery and Rehabilitation

Elbow dislocations in children are rare. 16 Stans A. Heirich S. Dislocations of the elbow. in: Beaty J. Kasser J. Rockwood & Wilkinś fractures in children. 7th ed. Lippincott Williams & Wilkins, Philadelphia, PA2010 Google Scholar , 14 Rasool M.N. Dislocation of the elbow in children. J Bone Joint Surg (Br). 2004; 86-B: 1050-1058https://doi.org/10.1302/0301-620X.86B7 Crossref Google Scholar They may be associated with other fractures of this region, with the most common being medial epicondyle avulsion. 4 Carlioz H. Abols Y. Posterior dislocation of the elbow in children. J Ped Othops. 1984; 4: 8-12 Crossref PubMed Scopus (68) Google Scholar In 15-18% of cases, the fragment is incarcerated within the joint. 2 Beaty J. Kasser J. The elbow: physeal fractures, apophyseal injuries of the distal humerus, osteonecrosis of the trochlea, and t-condylar fractures. in: Beaty J. Kasser J. Rockwood & Wilkinś fractures in children. 6th ed. Lippincott Williams & Wilkins, Philadelphia, PA2006: 592-660 Google Scholar Less common is the association with paralysis of the ulnar nerve, which may result from the injury itself, as well as from manipulation, such as in closed reduction, or during surgical treatment. Treatment of medial epicondyle fractures is controversial, with equally satisfactory results when comparing conservative treatment and surgery, even in cases of fractures with deviation. 7 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: 1299-1305 PubMed Google Scholar , 10 Hines R.F. Herndon W.A. Evans J.P. Operative treatment of medial epicondyle fractures in children. Clin Orthop Relat Res. 1987; 223: 170-174 PubMed Google Scholar , 11 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: 59-64 Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar However, open reduction with internal fixation of the epicondyle fragment is clearly indicated in cases of intra-articular entrapment of the fragment, on suspicion of entrapment of the ulnar nerve or in cases of marked instability of the elbow. 3 Bede W.B. Lefebvre A.R. Rosman M.A. Fractures of the medial humeral epicondyle in children. Can J Surg. 1975; 18: 137-142 PubMed Google Scholar , 5 Case S.L. Hennrikus W.L. Surgical treatment of displaced medial epicondyle fractures in adolescent athletes. Am J Sports Med. 1997; 25: 682-686 Crossref PubMed Scopus (66) Google Scholar , 8 Fowles J.V. Slimane N. Kassab M.T. Elbow dislocation with avulsion of the medial epicondyle. J Bone Joint Surg (Br). 1990; 72: 102-104 PubMed Google Scholar , 17 Wilson J.N. The treatment of fractures of the medial epicondyle of the humerus. J Bone Joint Surg (Br). 1960; 42: 778-781 Google Scholar , 18 Woods G.W. Tullos H.S. Elbow instability and medial epicondyle fractures. Am J Sports Med. 1977; 5: 23-30 Crossref PubMed Scopus (110) Google Scholar