Surgical treatment using a ‘two window approach’ for pediatric elbow fracture-dislocation with posteromedial rotatory instability: a report of two cases

Abstract

Background

Posteromedial rotatory instability (PMRI) of the elbow is usually treated with either the Hotchkiss Over-the-Top approach or the flexor carpi ulnaris (FCU) splitting approach. And there are no case reports of pediatric PMRI.

Case presentation

Case 1 is a 12-year-old boy who fell on his left outstretched hand. He was diagnosed with PMRI with an O'Driscoll type 2, subtype 3 coronoid fracture. The coronoid fragments were fixed using the ‘two window approach’: combining the Hotchkiss Over-the-Top approach and the FCU splitting approach. Case 2 is a 13-year-old boy who suffered an elbow fracture-dislocation with an O'Driscoll type 2, subtype 3 coronoid fracture. His PMRI was treated operatively with the same ‘two window approach’ as case 1.

Conclusion

This is the first case report of pediatric PMRI. By using the ‘two window approach’, we successfully and less invasively treated the anteromedial facet fractures of the coronoid process.