Entrapment of the Median Nerve Following Elbow Dislocation in Children: A Case Series

Background and Objectives: Median nerve entrapment following elbow dislocation is a very rare but serious condition in children. We describe four cases of median nerve entrapment, highlight diagnostic challenges, evaluate the impact of delayed treatment, and propose a treatment algorithm. Materials and Methods: A retrospective review of a consecutive case series of four children with median nerve entrapment following elbow dislocation was conducted. Clinical records, imaging, operative findings, and outcomes were reviewed. Results: In all patients, the causative injury was posterolateral elbow dislocation with an associated medial epicondyle fracture. Three patients had delayed diagnosis of their median nerve entrapment (at 10-31 months post-injury) and required nerve resection with sural nerve grafting; none achieved full neurological recovery. One patient underwent early exploration and decompression (at 4 days post-injury) and made a full recovery. Misattribution of neurological symptoms to transient neurapraxia, under-recognition of radiographic signs, and inadequate early advanced imaging contributed to delayed diagnosis and management. Magnetic resonance imaging was the most useful imaging modality for diagnosing median nerve entrapment, though initial reporting missed entrapment in one case. Conclusions: Prompt recognition and early surgical decompression are critical for optimal recovery in paediatric median nerve entrapment after elbow dislocation. Delayed treatment is associated with poor outcomes. We propose a treatment algorithm to guide management and improve outcomes.