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Medial Epicondyle Fracture Dislocation, Multiple Failed Reductions, and a Median Nerve Entrapment: A Case Report
Neal Chase Farmer1, Joseph Boesel1, David Yatsonsky2
1Department of Orthopedic Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH.
Insights
Pediatric medial epicondyle fractures can rarely cause median nerve (MN) entrapment, leading to progressive weakness and numbness. Early diagnosis and intervention are vital for favorable outcomes in pediatric elbow fracture patients.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Neurology
Background:
- Medial epicondyle fracture dislocations are common in children.
- While generally having good outcomes, these fractures can rarely lead to median nerve (MN) entrapment.
- Entrapment can occur within the joint or fracture site, causing progressive motor and sensory deficits.
Introduction:
Medial epicondyle fracture dislocations are common in the pediatric population; however, they often lead to favorable patient outcomes. Rarely, the median nerve (MN) can be trapped within the joint space or fracture upon reduction. If the nerve is trapped within the fracture, the MN slowly gets compressed as the fracture heals, leading to progressive deficits in motor function and sensation. These symptoms present as a mixture of pain, numbness, weakness, and paresthesia in the distribution of the MN. Therefore, careful monitoring of the patient post-reduction is crucial in making an early diagnosis.
Case Report:
A 9-year-old girl presented with an incarcerated MN following closed reduction of a left elbow medial epicondyle fracture after multiple reduction attempts. She presented 2 years post-injury with a healed medial epicondyle, median sensory deficits, and anterior interosseous palsy. Nerve studies showed deficits in median-innervated muscles. Operative exploration revealed the MN incarcerated within the healed fracture. Tendon transfer allowed for opposition and flexion of the thumb, index finger flexion, and composite fist formation.
Conclusion:
MN entrapment following medial epicondyle reduction may present as ongoing sensory changes and median innervated weakness. Electromyography and advanced imaging should be obtained expeditiously.
