Incarcération du nerf médian après luxation négligée du coude : à propos d’un cas

Ipsilateral Displaced Physeal Fractures of the Proximal and Distal Humerus with Subperiosteal Extrusion in a 6-Year-Old Child: A Case Report

CASE

We present a case of a 6-year-old male child with ipsilateral proximal and distal physeal separation of humerus with subperiosteal extrusion after manipulation by a bonesetter. Treatment included open reduction and internal fixation with Kirschner wire proximally and distally. At 1.5-year follow-up, the child had a shortening of 0.5 cm, no pain, and/or no instability.

CONCLUSION

Manipulation by bonesetters, a commonplace in developing countries, can produce unpredictable complications and compromise outcomes. Although accepted in certain settings, the regional orthopaedic surgeons should be mindful of the unique clinical challenges imposed by such a practice.

Posterior approach for surgical treatment of neglected elbow dislocation

INTRODUCTION

Neglected elbow dislocations often result in contracture and functional impairment. Surgical treatment is challenging because of the accompanying triceps retraction. We wanted to share our experience in treating these neglected dislocations using the posterior approach.

PATIENTS AND METHODS

This was a consecutive, prospective study over a 4.5-year period (January 2003 to June 2007) that included all the patients who presented with a neglected elbow dislocation that was older than 21 days. We treated 22 patients (17 men, five women) with an average age of 22.8±8.2 years (range 14 to 46 years). The dislocations were 8.5±4.2 months old on average (range 2 to 17 months). Average elbow flexion was 46.0°±25.9° (10° to 90°) and the extension deficit was 19.5°±18.4° (0° to 60°) before the surgery. A paratricipital approach was used in all patients. In 14 patients, the dislocation was reduced without triceps lengthening. In eight patients, a V-Y plasty of the triceps muscle was required.

RESULTS

The average follow-up was 21 months (range 12 to 30 months). The improvement in the overall range of motion was statistically significant. Average elbow flexion was 112.7°±13.3° (60° to 130°) and the extension deficit was 26.6°±17.0° (0° to 60°). The average Mayo Clinic Elbow Performance Index score was 86 (range 50 to 100), with 14 excellent, four good, two average and two poor results. Complications included three cases of ulnar nerve paresis, which subsided within three months, and one case of superficial infection.

DISCUSSION

Although surgical treatment is challenging, the functional improvement in neglected elbow dislocations is outstanding. The best functional results can be expected when the triceps splitting approach to the elbow is not used.

LEVEL OF EVIDENCE

IV.