Medial epicondyle fractures: clinical cases a pediatric hospital
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Keywords

Humeral fractures
elbow
fracture dislocation
fractures avulsion
ulnar nerve
child

How to Cite

Vergara Amador, E., & Castellar Torres, Y. (2019). Medial epicondyle fractures: clinical cases a pediatric hospital. Salud UIS, 51(4), 347–352. https://doi.org/10.18273/revsal.v51n4-2019008

Abstract

Medial epicondyle fractures represent 11-20% of elbow injuries in the pediatric population. Approximately 50% is associated with dislocation in the elbow. Incarceration is less frequent. The objective of this study is to describe the functional results of a cases of patients with medial epicondyle fracture and to review the subject. It is a descriptive and retrospective observational study of pediatric patients with medial epicondyle fracture, attended in a pediatric hospital. The medical records were reviewed and the data were analyzed in an Excel table. Study approved by the hospital ethics committee. 39 of 42 cases, met the inclusion criteria. The average age was 11.3 years (4-16 years). 77% were operated and the fracture was associated with dislocation of the elbow in 25.6%. The 7.6% of the cases had ulnar nerve neuroapraxia that they recovered spontaneously. The medial epicondyle fracture is observed in the pediatric population involved in high performance activities. Subdiagnosis can occur due to the complex ossification of the elbow and also to the superimposition of the medial epicondyle image with the humeral trochlea. It is associated with dislocation of the elbow between 25 to 50% of cases. The treatment of this fracture is orthopedic or surgical. The consolidation rates in both treatments are similar.

https://doi.org/10.18273/revsal.v51n4-2019008
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References

1. Lotz B, Akilapa O, Karthik K. Delayed reconstruction following incarceration of the medial epicondyle in the elbow joint. A case report and review of the literature. JBJS case connect. 2018; 8(3): e69. doi: 10.2106/JBJS.CC.17.00239.
2. Watson-Jones R. Fractures and joint injuries. Baltimore: Williams & Wilkins, 1946.
3. Beaty JH, Kasser JH. The elbow-physeal fractures, apophyseal injuries of the distal humerus, osteonecrosis of the trochlea, and T-condylar fractures. In: Beaty JH, Kasser JR, editors. Rockwood & Wilkins’ fractures in children. Philadelphia, PA: Lippincott Williams & Wilkins; 2005. pp. 628-642.
4. Mehlman CT, Howard AW. Medial epicondyle fractures in children. Clinical decision making in the face of uncertainty. J Pediatr Orthop. 2012; 32(Suppl 2): S135-142. doi: 10.1097/ BPO.0b013e31824bdb78.
5. Blount WP. Injuries about the elbow: fractures of the medial epicondyle. Fractures in Children. 1st edition. Baltimore: Williams & Wilkins; 1955: 55-61.
6. Patel NM, Ganley TJ. Medial epicondyle fractures of the humerus: how to evaluate and when to operate. J Pediatr Orthop. 2012; 32(Suppl 1): S10-13. doi: 10.1097/BPO.0b013e31824b2530.
7. Haflah NH, Ibrahim S, Sapuan J, Abdullah S. An elbow dislocation in a child with missed medial epicondyle fracture and late ulnar nerve palsy. J Pediatr Orthop B. 2010; 19(5): 459-461. doi: 10.1097/BPB.0b013e32833b6032.
8. Nussberger G, Schädelin S, Mayr J, Studer D, Zimmermann P. Treatment strategy and long-term functional outcome of traumatic elbow dislocation in childhood: a single centre study. J Child Orthop. 2018; 12(2): 129-135. doi: 10.1302/1863- 2548.12.170167.
9. Beck JJ, Bowen RE, Silva M. What’s New in Pediatric Medial Epicondyle Fractures? J Pediatr Orthop. 2018; 38(4): e202-e206. doi: 10.1097/ BPO.0000000000000902.
10. Vergara-Amador E, Muñoz D, Vela Rodriguez F. Descripción anatómica del origen de los músculos flexores y pronadores en el epicóndilo medial del húmero. Rev Cubana Ortop Traumatol. 2013, 27(2): 199-208.
11. Cruz AI Jr, Steere JT, Lawrence JT. Medial Epicondyle Fractures in the Pediatric Overhead Athlete. J Pediatr Orthop. 2016; 36(Suppl 1): S56-62. doi: 10.1097/BPO.0000000000000759.
12. Karatas A, Apaydin N, Uz A, Tubbs SR, Loukas M, Gezen F. Regional anatomic structures of the elbow that may potentially compress the ulnar nerve. J Shoulder Elbow Surg. 2009; 18(4): 627-631. doi: 10.1016/j.jse.2009.03.004.
13. Gottschalk HP, Eisner E, Hosalkar HS. Medial epicondyle fractures in the pediatric population. J Am Academ Orthop Surgery. 2012; 20: 223-232. doi: 10.5435/JAAOS-20-04-223.
14. Mehlman C, Howard A. Medial epicondyle fractures in children: clinical decision making in the face of uncertainty. J Pediatr Orthop. 2012; 32(Suppl 2): S135-142. doi: 10.1097/BPO.0b013e31824bdb78.
15. Pappas N, Lawrence JT, Donegan D, Ganley T, Flynn JM. Intraobserver and interobserver agreement in the measurement of displaced humeral medial epicondyle fractures in children. J Bone Joint Surg Am. 2010; 92(2): 322-327. doi: 10.2106/ JBJS.I.00493.
16. Souder CD, Farnsworth CL, McNeil NP, Bomar JD, Edmonds EW. The distal humerus axial view: assessment of displacement in medial epicondyle fractures. J Pediatr Orthop. 2015; 35(5): 449-454. doi: 10.1097/BPO.0000000000000306.
17. Farsetti P, Potenza V, Caterini R, Ippolito E. Long-term results of treatment of fractures of the medial humeral epicondyle in children. J Bone Joint Surg Am. 2001; 83(9): 1299-1305. doi: 10.2106/00004623-200109000-00001.
18. Stepanovich M, Bastrom TP, Munch J, Roocroft JH, Edmonds EW, Pennockc AT. Does operative fixation affect outcomes of displaced medial epicondyle fractures? J Child Orthop 2016; 10(5): 413-419. doi: 10.1007/s11832-016-0757-1.
19. Knapik DM, Fausett CL Gillmore A, Liu RW. Outcomes of nonoperative pediatric medial humeral epicondyle fractures with and without associated elbow dislocation. J Pediatr Orthop. 2017; 37(4): e224-e228) doi: 10.1097/BPO.0000000000000890.
20. Josefsson PO, Danielsson LG. Epicondylar elbow fracture in children: 35-year follow-up of 56 unreduced cases. Acta Orthop Scand. 1986; 57(4): 313-315. doi: 10.3109/17453678608994399.
21. Tarallo L, Mugnai R, Fiacchi F, Adani R, Zambianchi F, Catani F. Pediatric medial epicondyle fractures with intra-articular elbow incarceration. J Orthop Traumatol. 2015; 16(2): 117-123. doi: 10.1007/ s10195-014-0310-2.
22. Pace GI, Hennrikus WL. Fixation of displaced medial epicondyle fractures in adolescents. J Pediatr Orthop. 2017; 37(2): e80-e82. doi: 10.1097/ BPO.0000000000000743.
23. Louahem DM, Bourelle S, Buscayret F, Mazeau P, Kelly P, Dimeglio A, et al. Displaced medial epicondyle fractures of the humerus: surgical treatment and results. A report of 139 cases. Arch Orthop Trauma Surg. 2010; 130(5): 649-655. doi: 10.1007/s00402-009-1009-3.
24. Pathy R, Dodwell ER. Medial epicondyle fractures in children. Curr Opin Pediatr. 2015; 27(1): 58-66. doi: 10.1097/MOP.0000000000000181.
25. Fowles JV, Slimane N, Kassab MT. Elbow dislocation with avulsion of the medial humeral epicondyle. J Bone Joint Surg Br. 1990; 72(1): 102-104. doi: https://doi.org/10.1302/0301-620X.72B1.2298765.
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