Incarcerated Medial Epicondyle Fracture Following Pediatric Elbow Dislocation: 11 Cases

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 degrees to 140 degrees. All patients had forearm rotation from 90 degrees 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. (C) Copyright 2014 by the American Society for Surgery of the Hand. All rights reserved.