Case report
Unusual association of elbow dislocation with humeral biepicondylar fracture in a child: A case report and review of literature

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Abstract

Humeral biepicondylar fracture with elbow dislocation is an unusual pattern of injury encountered in paediatric population. We reported a case of humeral biepicondylar fracture-dislocation of elbow in a 11-year-old boy, who presented with tender, swollen, and deformed left elbow following fall on his outstretched hand. Roentgenographic and CT evaluation confirmed the diagnosis, and also showed incarcerated medial epicondylar fragment. Closed reduction was unsuccessful; open reduction and internal fixation was performed with headless screws. Avulsed medial collateral ligament was repaired with suture anchor. Following 4 weeks of immobilization, physiotherapy was started. The child regained satisfactory range-of-motion of the elbow with complete bony union within 3 months. Two years following operation, the child is asymptomatic, with pain free stable elbow. High index of suspicion and astute clinical and radiological assessment is utilitarian for timely diagnosis and appropriate management. Open reduction and internal fixation is believed to be pivotal to restore elbow stability and functionality.

Introduction

Fractures around the elbow are commonplace in paediatric age group; however, elbow dislocation is relatively rare accounting for 3 to 6% of all elbow injuries.1 Concomitant fractures or avulsion injuries are encountered in substantial number of paediatric elbow dislocations (64 to 75%), which mandate careful radiological assessment very crucial. Avulsion of the medial epicondyle is by far the most common associated injury (25 to 36%); on the contrary, concomitant injuries of the lateral compartment are infrequent.1, 2 Humeral biepicondylar elbow fracture-dislocation is a very unusual pattern, which is exemplified by the fact that only few case reports are published so far.3, 4, 5, 6, 7

We report a case of biepicondylar fracture with elbow dislocation in a 11–year-old boy. We also intended to review relevant literature concerning mechanism of injury, diagnosis and management of this unusual injury pattern. Appropriate consent was obtained from parents for reporting the case and radiographs.

Section snippets

Case report

A 11-year-old boy presented to the emergency department of our hospital within 3 h of sustaining injury to his left upper limb following fall from bed on his outstretched arm. Clinical examination revealed grossly swollen and deformed left elbow, which was tender to palpation on both medial and lateral aspect. Neuro-vascular status of that limb was intact, and further work-up did not find any other associated injury. Roentogenographic assessment with anteroposterior (AP) and lateral view of the

Discussion

Incidence of medial epicondyle fracture is next to supracondylar and lateral condyle fracture in paediatric population. It is most frequently associated with elbow dislocation.5 Usual mechanism of injury is valgus avulsion forces exerted by the flexor-pronator muscle mass during fall on outstretched hand, when elbow is locked in extension and wrist and fingers are hyperextend. Normal valgus carrying angle is postulated to accentuate the avulsion forces. Ulnar collateral ligament is purported to

Conflict of interest

The authors have none to declare.

Acknowledgement

None.

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