Medial Epicondyle Fracture With Associated Elbow Dislocation In An Adolescent

摘要

Injuries to the medial aspect of the distal humerus in young children can range from an avulsion fracture of the medial epicondyle to a much more serious Salter-Harris type IV fracture of the medial condyle, which crosses the physeal plate. The distinction between these types of fractures is key to the selection of appropriate treatment. This diagnosis may be difficult to ascertain due to the limitations of radiographic visualization of cartilaginous fractures observed with the developing anatomy in this area. Inadequate reduction of the physeal growth plate and the joint surface cartilage in a medial condyle fracture can lead to serious complications. Case Report This is a case of a 16 year old adolescent boy who had a fall at home. The boy was apparently standing up on a stool trying to change bulb when the stool moved and he fell down. He claims had a fall with his right upper limb outstretched while trying to block the fall and as he hit the floor, his elbow was put in valgus stress.Immediately after the fall he was not able to move his right elbow anymore and associated with swelling, severe pain and deformity.He has no significant past medical or surgical history.Examination revealed a swollen right elbow kept in flexion. Severe tenderness was noted on palpation over the medial epicondyle and clinically the elbow was dislocated posteriorly. There were no neurovascular deficits.Plain radiographs of his right elbow showed posterior dislocation of right elbow with a piece of bone trapped within the joint. (Figure 1) Treatment Closed manual reduction was done immediately under sedation and was immobilized with above elbow pop with elbow in flexion. He was later admitted to the ward with limb elevation and regular analgesics were given. Repeat X-ray showed that the joint was reduced with the bone piece successfully removed from the joint. (Figure 2)Daily neurovascular assessment was done and showed no deficits.Open reduction of the fracture site with cannulated screw fixation and K wiring of the medial epicondyle of right elbow was done on the 30/8/07.The K wire was buried under the skin.Prophylactic antibiotic was given pre and post operativelyHis elbow was protected with above elbow back slab post operatively and he was later discharged from the ward on the post operative day 2. Follow up He was seen back in clinic on the 20/9/2007 (3 weeks post operatively).Check X-ray was done and showed a well reduced fracture with minimal callus formation. The K wire was noted to be piercing out of the skin and it was removed. However there were no signs of wound infection. The back slab was removed and he was started on physiotherapy for elbow range of motion.He was seen again in clinic 4 months later with full range of movement of his right elbow. X ray showed united fracture.