Pediatric Elbow Dislocation
HPI: Pediatric male presents after a fall onto outstretched arm with obvious deformity to right elbow.
PE: Patient is unable to cross fingers and has paresthesias in the ulnar nerve distribution. Initial radiograph showed posterior dislocation with questionable hyperdensity representing the medial epicondyle. We were unable to reduce under fluoroscopy as the medial epicondyle was more visible and the patient eventually required ORIF.
Imaging: AP and lateral radiograph of the elbow
Image 1: Showing associated medial epicondyle fracture
How to Diagnosis: Two important lines help in making the diagnosis; radiocapitella and anterior humeral.
Radiocapitellar line: Drawn through the center of the radial neck and should pass the center of the capitellum as shown below
Anterior humeral line: Drawn through the lateral view of the surface of the humerus and should pass through the middle of the capitellum
Ossification: 6 sites that fuse at different ages. Mnemonic = CRITOE
Treatment: Nonoperative with closed reduction and early range of motion (1-2 weeks) is most common. ORIF required for incarcerated medial epicondyle, inability to obtain close reduction, or significant instability.
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