Pediatric Elbow Dislocation Research Articles

Management of Pediatric Elbow Fractures and Dislocations.

Pediatric elbow fractures and dislocations have always been a challenge from a diagnostic and therapeutic point of view, primarily due to the complex nature of the pediatric elbow, especially its developmental anatomy. They must be diagnosed and treated on time to prevent numerous complications with long-term consequences. With the development of radiology and pediatric surgery and orthopedics, as well as the development of modern osteosynthesis materials, concerning current scientific and professional knowledge, the outcomes are getting better, with fewer acute and chronic complications. This comprehensive review aims to provide clinicians current knowledge about pediatric elbow fractures and dislocations so that in daily practice they have as few doubts as possible with the best possible treatment outcomes.

Entrapment of Median Nerve After Pediatric Elbow Dislocation with a Brief Review of Literature: A Case Study.

We present a case of type II (intraosseous) entrapment of the median nerve in a patient who was diagnosed based on clinical examination and magnetic resonance imaging and who was treated with medial epicondyle osteotomy, neurolysis, and transposition of the nerve to its anatomical position within a month of injury. Our patient made a complete motor and sensory recovery at 5 months with complete functionality and grip strength. Median nerve entrapment after posterolateral elbow dislocation is a rare complication with roughly 40 cases reported in the literature. This case illustrates the importance of prompt diagnosis and treatment.

Pediatric Elbow Dislocations and Associated Fractures.

The objective was to evaluate pediatric patients with acute elbow dislocation and/or associated fracture to determine which were indicated for surgical intervention, using a single institution, Institutional Review Board (IRB) approved retrospective review of patients who presented to the Emergency Department (ED) with an acute elbow dislocation. Inclusion criteria were age ≤ 18 years, acute elbow dislocation injury, and appropriate imaging. A total of 117 patients were included 37 had a simple elbow dislocation, 80 had an associated fracture (medial epicondyle 59, lateral condyle 9, radial head/neck 7, other 5). A total of 62% (73/117) were male. The average age was 10.3 years (range 4-17). Mechanisms of injury included: falls from height/playground equipment (46), trampoline (14), and sports (57). All 37 patients with a simple elbow dislocation were successfully treated with closed reduction. Of the 80 patients with an associated fracture, 30 (38%) went on to open reduction internal fixation (ORIF). A total of 59 patients had an associated medial epicondyle fracture; 24 (41%) of whom went on to ORIF. Nine patients had an associated lateral condyle fracture, five (56%) of whom went on to ORIF. Patients with a simple elbow dislocation can be successfully treated with a closed reduction in the ED. However, 30/80 patients with an associated fracture (medial epicondyle, lateral condyle, or radial neck) required operative management.

Clinical and functional outcomes of pediatric elbow dislocations: Level 1 tertiary trauma center experience

Background/Aim: Traumatic elbow dislocations have been reported as uncommon in pediatric population. Because of low frequency, there are not many studies on the subject in the literature. The aim of this study was to retrospectively evaluate the radiological and functional results of pediatric patients treated for elbow dislocations in a level-1 tertiary trauma center and to compare the results of simple and fractured dislocations. Methods: This is a retrospective cohort study of a single center experience diagnosed with pediatric elbow dislocations between 2015 and 2019. The cases were evaluated by dividing them into two groups as simple dislocations and fracture dislocations. Demographic features, injury mechanism, treatment, complications and Mayo elbow performance score (MEPS) were evaluated. Results: Fifty-seven patients, (46 male/ 11 female), were included in the study, with a mean age of 11.1 (3-15) years. Mean follow up time was 27.2 (12-51) months. While 30 patients had fracture dislocations, 27 patients had simple dislocations. Of 30 patients with fracture dislocations, 19 were operated. Nonunion in the medial epicondyle in five patients, AVN (avascular necrosis) in radial head in two patients, heterotrophic ossification in one triceps, and recurrent dislocation in one patient were detected. According to MEPS, 42 (73%) of 57 patients were excellent, 12 (21%) good, one (2%) moderate, and two (4%) poor. According to MEPS, functional results of simple dislocations were found to be better than those of fracture-dislocations, and this result was statistically significant (P

Pediatric anterior elbow dislocation due to a rare mechanism of injury: A case report.

Introduction & importanceElbow dislocations are rare among the pediatric population as their ligaments are stronger than bones. Anterior dislocations of the elbow are even rarer entity usually caused by anteriorly directed force on the hyper-flexed elbow. We present a case of a rotational force on an extended elbow causing anterior dislocation of the shoulder in an 11-year-old boy.Case presentationAn 11-year-old boy presented to the Accident & Trauma unit with pain & swelling of the right elbow following a twisting injury by a spinning washing machine. The child was in pain.Clinical discussionHis elbow was semi flexed and deformed. Distal neurovascular status was found normal. Radiographs of the right elbow revealed anteromedial dislocation of the elbow with the medial epicondyle avulsion. Emergent relocation of the elbow joint has been performed. A concentric reduction, absence of incarcerated bony fragments and stability has been confirmed by the fluoroscopic examination. Post reduction neurovascular examinations unremarkable. The child was discharged with the above-elbow splint. The range of motion exercises has been commenced after three weeks. The child achieved full range of motion at six weeks of post-injury.ConclusionAnterior dislocations are a rare entity in pediatric orthopaedic practice. Evaluation of the causative mechanism of injury is the clue. A rare type of mechanism of injury also should be kept in mind to prevent the delay in diagnosis and treatment.

Post-traumatic entrapment of the median nerve in the ulno-humeral joint: Diagnosis, treatment and literature review

BackgroundThe incidence of median nerve injuries in pediatric elbow dislocations is approximately 3% and avulsion of the open medial epicondylar epiphysis in the pediatric population is one predisposing factor that may explain this age predilection. These lesions can be difficult to diagnose in the acute phase because symptoms tend to be mild or delayed, consequently their management can be challenging and functional outcome poorer. MethodsWe present the case of an unrecognized median nerve entrapment in a 16-year-old boy with posterior dislocation of the elbow and a medial epicondyle fracture, treated initially with close reduction and open stabilization with a cannulated screw. Assessment is supported by a review of similar reported cases available in literature. ResultsWe discuss the diagnostic approach and the surgical options that can be used for this type of injury. ConclusionsHigh clinical suspicion of entrapment is imperative in presence of signs of damage to the median nerve in the pediatric patient immediately after the reduction of an elbow dislocation. If diagnosis of entrapment is made the therapeutic choice between neurolysis and nerve graft depends on the lesion severity. In the presence of a Fourrier's type 4 lesion, neurolysis should be avoided, while nerve resection and grafting are recommended.

Clinical and functional outcomes of pediatric elbow dislocations: a single centre experience

Clinical and functional outcomes of pediatric elbow dislocations: a single centre experience

Standardized sonographic examination of pediatric elbow injuries is an effective screening method and improves diagnostic efficiency

IntroductionPositive role of ultrasound in the diagnosis of pediatric elbow injuries were confirmed by many papers but no comprehensive, standardized method has been developed for daily clinical practice. The aim of our prospective diagnostic study was to prove the efficacy of a five point sonographic point of care method for detecting different pediatric elbow fractures or dislocations. MethodsBetween 2016 January and 2017 March 365 children (age 1–14) with suspected closed elbow injury were enrolled in our study. Sonographic point of care examination was carried out by a properly trained resident and two orthopedic surgeons immediately after physical survey. We used a standardized five point sonographic examination. Two plane x-rays were made following sonography according to protocol. Utility of sonographic pictures were analyzed by a radiologist. Cases with images which have not met with standard requirements were excluded. In those cases when primary x-rays were negative and/or any of the ultrasound planes showed positive findings, radiography was repeated after 4 weeks of injury. If we detected callus formation the fracture was considered occult. Cases with images which have not met with standard requirements were excluded. Ultrasonic pictures, evaluation sheets and x-ray results were compared. ResultsOut of the 365 cases we identified 165 with positive findings (45, 2%) by primary x-rays. Distribution of the different injuries were the following: Radial condylar fractures, (n = 29) supracondylar humeral fractures (n = 84 proximal radial fractures, (n = 19) proximal ulnar fractures, (n = 7) fractures with joint dislocations (n = 3) joint dislocations without fractures, n = 2 medial epicondyle fractures (n = 14) fracture combinations (n = 7) We did not find injuries in this series that we could not categorize into these groups. Evaluating the abnormal sonographic dorsal fat pad sign (FPS) as a sole parameter for fracture detection we found sensitivity: 0, 97, specificity: 0,97, positive predictive value: 0,97, negative predictive value: 0,97 Evaluating the effectivity of the four cortical planes we calculated sensitivity 0, 85 specificity 0.96 positive predictive value: 0. 95 negative predictive value 0.87. The overall values of the five planes were the following: specificity0.97 sensitivity 1, positive predictive value 0.97 negative predictive value: 1 Interrater agreements on the cortical plane abnormality were considered good at two examiners and very good at one examiner. (Kappa = 0.79, 0, 81, 0, 79) Agreements on differentiation of elevated, normal fat pad) or lipohaemarthrosis in sonographic pictures were very good in all cases. (Kappa = 0,83, 0,86,0,82) While identification of any displacement or dislocation was possible in 96%, of all cases(n = 59)the exact determination of the type of the injury was possible in only 70,3% (n = 116) ConclusionsUsing the five point ultrasonic examination provides enough information for excluding or confirming the presence of any pediatric elbow fractures or dislocations. The method is quick, simple and can help in the immediate differentiation of the severity of injuries. Sonographic lipohaemarthrosis seems to be more sensitive than elevated fat pad sign for the detection of potential occult fractures. Positive cases should be cleared by x-rays because the exact nature of the fractures are not identifiable only by ultrasound.

Pure Medial Elbow Dislocation without Concomitant Fracture in a 10-Year-Old Child.

Pediatric elbow dislocations are rare injuries and are often accompanied by concomitant fractures. We report a rare case of medial dislocation of the right elbow without accompanying fracture in a 10.5-year-old boy after fall from a bicycle. After radiographic and magnetic resonance imaging evaluation, closed reduction under general anesthesia was performed and the elbow was immobilized in a posterior above-elbow slab. Elbow mobilization was started after 2 weeks and the posterior slab was discontinued after 4 weeks. At 3 months, the patient had a full range of active elbow flexion extension and pronation supination. At 4-year followup, radiographs show a normal alignment of the elbow with mild changes of heterotopic ossification. We believe that this is the first such case ever reported in literature. Early recognition and prompt diagnosis is the key to achieve a good result.

Incarcerated Coronoid Fracture at the Time of Pediatric Elbow Dislocation

Incarcerated Coronoid Fracture at the Time of Pediatric Elbow Dislocation

Early Outcomes of Pediatric Elbow Dislocation-Risk Factors Associated With Morbidity.

Ulnohumeral elbow dislocation is a rare elbow injury in children. We reviewed a large cohort of pediatric ulnohumeral elbow dislocations and sought to identify risk factors associated with poor functional outcomes. Medical charts and radiographs were reviewed for all acute pediatric ulnohumeral elbow dislocations evaluated at our facility during a 7-year period. Charts were abstracted for demographics, injury characteristics, treatments, and complications. Functional outcomes were assessed at minimum 6-week follow-up using a combination of symptoms and elbow range of motion (Roberts criteria). A total of 145 cases qualified for inclusion and were analyzed. The average age at injury was 11 years (range, 5 to 18 y), with equal distribution between male and female individuals. Concomitant elbow fractures were identified in 114 (80%) cases; the most common was the medial epicondyle (80/134, 60%). Treatment consisted of open reduction and fixation of associated fracture(s) in 59% of fracture cases. At an average follow-up of 3.7 months, the average range of motion was -5-degree extension to 126-degree flexion. Immobilization for longer than 2 weeks resulted in a loss of elbow extension (P<0.001). Functional outcomes as assessed by the Roberts criteria were good or excellent in 90% of cases. Risk factors associated with less than excellent functional outcomes included the presence of multiple fractures (P=0.001), the need for operative intervention (P=0.01), and the duration of immobilization (P=0.03). Complications requiring further treatment occurred in 16 cases (11%). Patients without complication resulted in a higher proportion of "excellent" functional outcomes (76%) compared with those with a complication (40%) (P<0.001). The majority of pediatric ulnohumeral elbow dislocations experience good to excellent functional outcomes by early follow-up. Risk factors associated with less than excellent functional outcomes include the presence of multiple associated fractures, operative intervention, and prolonged immobilization. Complications requiring operative intervention are not rare, and have a significant effect on functional outcomes. Level IV-prognostic.

Radiographically-Occult Injuries Associated with Pediatric Elbow Dislocations

Radiographically-Occult Injuries Associated with Pediatric Elbow Dislocations

Brachial artery repair using the basilic vein as a reliable conduit in a 3-year-old child

A supracondylar fracture of the humerus is the most common upper extremity fracture in children with concurrent neurovascular complications. However, bypass grafting in the management of a pediatric open elbow dislocation with an arterial injury has rarely been reported in the literature. Hence, an adequate conduit for a vessel graft interposition remains questionable when a primary anastomosis is limited in an arterial reconstruction. The purpose of this study is to present a brachial artery reconstruction in a 3-year-old patient with an open supracondylar fracture of the humerus. In the clinical and surgical examination of the patient, an open wound in the left antecubital fossa presented with accompanying brachial artery injury. To repair the artery, a reverse end-to-end anastomosis was conducted using basilic vein graft from the ipsilateral arm under general anesthesia. The patient had palpable radial pulses in the postoperative clinical examination and was discharged without complications. The great saphenous vein (GSV) has proven to be the most common and the best conduit for arterial reconstruction of the upper extremity in the adult patients. However, the GSV graft is known to have the propensity for becoming aneurysmal in pediatric patients. Some studies have demonstrated the basilic vein as a suitable conduit in pediatric patients, in that it has durable patency, fewer branches, size compatibility for anastomosis, and proximity to the brachial artery. Our case confirms the safety of using this autogenous vein from within the zone of injury for arterial reconstruction, after a supracondylar humeral fracture. The management of pediatric elbow fractures accompanying vascular injuries can be technically demanding due to relatively small, delicate structures and concurrent neurovascular network. Nonetheless, a vascular injury should be treated with high level of suspicion and immediate intervention to avoid any limb ischemia or loss. In situations where the brachial artery is compromised and needs repair with a bypass, the basilic vein should be considered as a conduit for its greater accessibility and long-term patency.

Radiographically-Occult Injuries Associated with Pediatric Elbow Dislocations

Radiographically-Occult Injuries Associated with Pediatric Elbow Dislocations

Posterior Migration of a Pediatric Coronoid Fracture: A Case Report.

Coronoid fractures are uncommon, with an incidence of 5.21 per 100,000 patients per year; they typically occur during elbow dislocation1. They are rarely seen in children, and to the best of our knowledge, pediatric cases have been described in only a few previously published case reports2-6. This may be attributed to the low frequency of pediatric elbow dislocations, which represent only 3% of elbow injuries7. The coronoid process is important for elbow stability because it extends the ulnohumeral joint and acts as a buttress to prevent posterior displacement of the ulna. Elbow dislocations occur when an axial load is applied to a hyperextended and externally rotated elbow8. We report a unique pediatric elbow case involving a posteriorly displaced coronoid process and a concomitant lateral condyle fracture; a thorough radiographic analysis was instrumental in the management of the fracture. The patient and his guardian were informed that data concerning the case would be submitted for publication, and they provided consent. A five-and-a-half-year-old boy presented to his primary care provider seven days after a fall from a trampoline and was noted to have a right elbow fracture. He was referred to our orthopaedic clinic for additional evaluation thirteen days after the injury. Upon presentation, the boy held the arm at his side, and mild tenderness was noted along the antecubital fossa. He remained neurovascularly intact but lacked 5° of elbow extension. Elbow radiographs demonstrated a minimally displaced lateral condyle fracture and bone fragmentation anterior to the coronoid process (Fig. 1). The elbow was placed in a posterior splint. Because the lateral condyle and coronoid fractures were concerning for an occult elbow subluxation, magnetic resonance imaging (MRI) with sedation was performed the same day to further delineate the fracture pattern and guide management. …

Incarcerated Medial Epicondyle Fracture Following Pediatric Elbow Dislocation: 11 Cases

To describe outcomes after surgical management of pediatric elbow dislocation with incarceration of the medial epicondyle. 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. 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° to 140°. All patients had forearm rotation from 90° 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. 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. Therapeutic IV.

Convergent and divergent dislocation of the pediatric elbow

Convergent and divergent pediatric elbow dislocations are rare injuries. When properly diagnosed and treated without delay, both types of dislocations have a good prognosis. We describe a case of convergent elbow dislocation in a 16-year-old boy. The patient underwent operative intervention and demonstrated full range of motion at the 4-year follow-up. Our second case describes an 11-year-old boy with a divergent elbow dislocation associated with an ipsilateral distal radius fracture and distal radioulnar joint dislocation. The patient showed full range of motion 1 year after closed reduction and casting and had no residual deformities or abnormalties.

Intraosseous Median Nerve Entrapment Following Pediatric Posterior Elbow Dislocation

Intra-articular entrapment of the median nerve following reduction of a pediatric posterior elbow dislocation is a rare complication but has been reported in the literature.This article describes a case of a 7-year-old girl who sustained a posterior elbow dislocation associated with a medial epicondyle fracture and the subsequent intraosseous entrapment of her median nerve. The entrapment is believed to have resulted from new bone formation over the nerve that went unrecognized for nearly 2 years following injury. Routine imaging studies failed to detect the entrapment prior to exploratory surgery. Intra-articular entrapment of the median nerve must be suspected following pediatric elbow dislocation when concentric reduction fails, postreduction images demonstrate joint widening, or the patient has persistent clinical symptoms. This case demonstrates the potential for delay in diagnosis of the cause for neurological impairment following a relatively common injury in the pediatric population.Objective intraoperative findings and intraoperative micropathology aided in limiting the amount of nerve resected to nonviable portions. Our case demonstrates the potential use of a cable nerve graft to bridge segmental defects in peripheral nerves.

Pediatric Elbow Dislocation Associated with Proximal Radioulnar Translocation: A Report of Three Cases and a Review of the Literature

Pediatric Elbow Dislocation Associated with Proximal Radioulnar Translocation: A Report of Three Cases and a Review of the Literature

Pediatric Elbow Dislocation Associated with Proximal Radioulnar Translocation

Combourieu, Benoit MD1; Thevenin-Lemoine, Camille MD1; Abelin-Genevois, Kariman MD1; Mary, Pierre MD1; Damsin, Jean-Paul MD1; Vialle, Raphaël MD, PhD1 Author Information