Spontaneous Reduction of Elbow Dislocation with Entrapment of Medial Epicondyle in Children: A Case Report

INTRODUCTION: Elbow dislocation accounts 3-6% of all pediatric elbow injuries. Medial epicondyle is the most common fracture related to the elbow dislocation in pediatric population. About 15-18% of medial epicondyle fractures related to dislocation present with the incarceration of medial epicondyle in the elbow joint after reduction. This situation is the only absolute surgical indication for epicondyle fracture in this population. CASE REPORT: A 15-year-old male children admitted to the emergency department with swelling, pain, and limitation of elbow range of motion after falling off a horse. Plain radiographs of the elbow revealed incongruity and increase in joint space of the elbow. When looked at carefully the medial epicondyle was seen not in the anatomic position but in the joint. Urgent surgery was performed. The medial epicondyle was removed from the joint and fixed its position with a 4 mm diameter cannulated lag screw, under fluoroscopy control. Then, the tear of the origin of flexor muscle groups on medial epicondyle was repaired with a 5.5 mm suture anchor. CONCLUSION: Due to the well-established association between elbow dislocation and incarcerated medial epicondyle fracture, it is easy to address the entrapment of bone fragment into the joint if any suspicion exists after reduction. However, spontaneous reduction of elbow dislocation is also possible, and it leads to the challenge of diagnosis. Due to that reason, surgeon must suspect the possibility of medial epicondyle entrapment if there is gross swelling, crepitation, and limitation of elbow range of motion although there is no dislocation.