Irreducible Fracture Dislocation of the Elbow Due to Medial Epicondyle Entrapment Associated with Median Nerve Palsy in Adult: A case report

Abstract

Purpose: Medial epicondyle fractures are common elbow injuries in pediatric and adolescent population. However, this condition is extremely rare in adults, with only a few cases reported in the literatures. This report presents the case of an adult patient with an irreducible fracture dislocation of the elbow due to intra-articular entrapment of the medial epicondyle associated with median nerve palsy. Methods: A case of 36-year-old man presented with posterolateral fracture dislocation of the left elbow with displaced medial epicondyle and median nerve palsy. Closed reduction was attempted, resulting in a grossly unstable elbow. Post-reduction radiographic study demonstrated the articular incongruence with the entrapped medial epicondyle. The patient underwent an open reduction and median nerve exploration. A fragment of the medial epicondyle was found comminuted and repaired using our novel technique with suture anchors. The lateral ulnar collateral ligament was repaired because of varus residual instability. The dislocated elbow was successfully reduced. Results: At 6 months follow-up, the elbow was stable with nearly full range of motion, although radiographic studies demonstrated union fractures with partially fragment resorption. Both sensation and motor function of the median nerve were gradually recovered. Conclusions: We presented a novel fixation technique for a rare case of irreducible fracture dislocation of the elbow due to intra-articular entrapment of the medial epicondyle associated with median nerve palsy in adults. The median nerve should be explored in every case, and delayed diagnosis should be avoided, which may lead to devastating complications.