A Neglected Markedly Displaced Medial Epicondyle Fracture with Simultaneous Ulnar Nerve Palsy in an Adolescent

Humeral medial epicondyle fractures constitute around 15% of pediatric elbow fractures. Up to 60% occur in association with elbow dislocations. Knowledge of potential imaging pitfalls when examining acute elbow fractures in children contributes significantly to accurate diagnosis. Nevertheless, management of missed pediatric medial epicondyle fractures has rarely been reported. We present an 11-year-old boy with a neglected and severely displaced medial epicondyle fracture with concurrent ulnar nerve palsy. We performed neural decompression, fragment excision, and muscular and capsuloligamentous reconstruction of the medial elbow. This study demonstrates that the surgical outcome of a late presenting fracture can be satisfactory in terms of function and neural recovery. It also underscores the importance of careful interpretation of elbow imaging including normal anatomic variants.

Management of wrist drop in children with Erb's palsy

There are two main types of obstetric brachial plexus palsy [OBPP]: Erb's and total palsies. Children with total involvement of the brachial plexus [C5-Tl] have poor hand function and are not candidates for limb reconstruction. In children with Erb's type of palsy restoration of active wrist extension is important as an effective hand grip is only possible with the wrist extended. The aim of this study is to evaluate the results of flexor carpi ulnaris [FCU] to extensor carpi radialis brevis [ECRB] transfer to restore active wrist extension and consequently establish an effective hand grip in patients with C5-7 pattern of Erb's palsy. Fifteen children with OBPP and wrist drop [C5-7 pattern of involvement] underwent FCU to ECRB transfer. The wrist drop was reconstructed in all patients who were consequently able to perform an effective hand grip. This study confirms that FCU to ECRB transfer in patients with OBPP and wrist drop is a simple and effective technique provided the selection criteria are respected

Modified Hoffer procedure for children with Erb's palsy

The Hoffer technique in which the tendons of the latissimus dorsi and teres major are transferred to the rotataor cuff-posterior to the long head of the triceps - has been reported to result in significant improvement in both external rotation and abduction of the shoulder. During an 18-month period, 13 children with obstetric brachial plexus palsy [C5-C6 pattern of involvement] underwent a stimultaneous subscrapularis recession and transfer of the tendons of the latissimus dorsi and teres major muscles to the rotator cuff through a single posterior incision. The age at time of surgery ranged from 4-8 [average 5.5] years. Follow up ranged from 13-31 [average 18] months. All patients improved following surgery. The average gain in external rotation was 51.5° and in abduction was 61.6°. This study further emphasizes the results of previous authors regarding improvement of shoulder external rotation and abduction following the Hoffer procedure. A modification of the original procedure is described allowing correction of the internal rotation contracture and tendon transfer through a single incision