Name:
Child's Neglected Medial Epicondyle Fracture, Interposed into the Ulnohumeral Joint: How to Manage
Description:
Child's Neglected Medial Epicondyle Fracture, Interposed into the Ulnohumeral Joint: How to Manage
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/ef2e5922-272c-42c7-a15c-c20d9b9b18d2/videoscrubberimages/Scrubber_1.jpg
Duration:
T00H05M52S
Embed URL:
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Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/ef2e5922-272c-42c7-a15c-c20d9b9b18d2/CHILD%27S NEGLECTED MEDIAL EPICONDYLE FRACTURE%2c INTERPOSED INT.mp4?sv=2019-02-02&sr=c&sig=v1jKDSqpzK%2BTcQoDrFnjH0%2Fau4dex0z8P1MJEVdfpPQ%3D&st=2024-11-21T17%3A12%3A12Z&se=2024-11-21T19%3A17%3A12Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
Hello, my friends, how are you? This is me, Dr. Sergio Rowinski, from shoulder planet, here from the city of Sao Paulo, Brazil. In this video, I'm showing you a very interesting case about a neglected medial epicondyle fracture, in a kid's elbow. So in this video, I'm showing you interesting tips and tricks in order to diagnose this case, not to miss the diagnosis, and still some interesting tips and ideas to manage this case,
intra operatively, so I hope you like the video. Please, don't forget, Subscribe, give us your thumbs up, leave your comment, and let us see this nice video. Medial epicondyle fractures in children are quite common, and they have to be surgically fixed, once they are displaced. Anyway, sometimes the medial
epicondyle can be interposed into the ulno-humeral space, and that is quite a rare situation, and this is what this presentation is, so, about. So this case is about an 11-year-old girl, who had a fall, onto her outstretched right arm, in August 2011, and developed immediate pain. She was taken to a local hospital, when the doctor that initially saw her diagnosed that condition just as a simple elbow contusion.
After four weeks, the patient's mother started to found strange that the kid's right elbow was not moving, and so the kid was brought to our hospital. So we asked for some x-rays, and the initial front view revealed that the medial epicondyle was not only broken, but, as we can see here, much probably interposed into the ulno-humeral joint. We asked for a lateral view, as we can see now, revealing that the medial epicondyle was not only in place, but much probably dislocated into the ulno- humeral joint.
In these cases, it is mandatory to ask for the other side X-ray. So this is the other side, the left elbow front view, revealing what was the normal anatomy of that patient. And when we compare both front views, it was quite clear for us that the medial epicondyle of the right elbow was definitely not in a good position. It was broken,
and, as I have already said, much probably interposed into the ulno-humeral joint. A CT really can help a lot in such cases, and here we see some images, in the sagittal plane, revealing that the medial epicondyle was into the ulno-humeral joint. 3D CT can help a lot, too, and here we see the medial view, with the whole medial epicondyle into the joint, and here we see an interior 3D CT view, revealing that the medial epicondyle was fully dislocated into the elbow. So this kid was operated five weeks after the trauma, and we performEDa medial standard approach.
The ulnar nerve was carefully identified and isolated, and the medial epicondyle was removed from the ulno-humeral joint. After that, it would have to be fixed with two K wires under C-ARM control. In this video, we can see that the medial epicondyle was fully removed from the joint, and once the assistant performs a varus stress upon the elbow, the fragment can be easily reduced, as we are seeing here.
Now we can see that the fragment was already fixed with two K wires. And, after that, the elbow could be flexed and extended, revealing that a good reduction was so achieved. Here we see the post op front view, done one week after surgery, showing an anatomical reduction of the medial view epicondyle. And this is the lat view, done one week after surgery, too, revealing a very good reduction.
So the K wires were removed after six weeks after that surgery, and that patient had a very good outcome. So this case is very interesting to show that a lot of attention must be paid to elbow cases, to elbow fractures, in kids. And a nice thing to remember is that the other side X-rays really can help a lot.
Thank you. So, my friends, I hope you liked the video, so, please, do not forget, subscribe, leave your comment. Show it to your friends, Help me spreading this channel. And, as Doctor Sergio always says, Never stop flying.
See all my good friends.
