Medial Epicondyle Fracture Dislocation, Multiple Failed Reductions, and a Median Nerve Entrapment: A Case Report.

Abstract

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.