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

Abstract

Elbow dislocations in children are rare. They may be associated with other fractures of this region, with the most common being medial epicondyle avulsion. In 1518% of cases, the fragment is incarcerated within the joint. 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. However, open reduction with internal fixation of the epicondyle fragment is clearly indicated in cases of intraarticular entrapment of the fragment, on suspicion of entrapment of the ulnar nerve or in cases of marked instability of the elbow. The authors present the case of a 10-year-old boy with a posterior dislocation of the left elbow, and a fracture of the medial epicondyle that was not initially recognized until he developed ulnar nerve palsy 3 months later. To date, the authors found only 1 case in the English language literature involving a detailed description of the history and approach of this type of injury.