Outcomes of therapy and ulnar nerve transposition for elbow stiffness after pediatric medial epicondyle fractures

PURPOSE: Following medial epicondyle fractures, a subset of pediatric patients has persistent limitations in elbow motion. This study soughted to understand the patient characteristics of this group and to assess the effectiveness of intensive therapy and ulnar nerve transposition in improving elbow range of motion and patient-reported outcomes. METHODS: A cohort of 31 pediatric patients with stiffness after elbow trauma was narrowed to 8 pediatric patients (7 female) ranging in age from 9 to 14 years, who were diagnosed with medial epicondyle fractures and underwent intensive therapy and ulnar nerve transposition with or without elbow joint release. We collected demographic and objective data as well as subjective data including Patient-Reported Outcome Measurement Information System (PROMIS) scores before and after ulnar nerve transposition. RESULTS: Following initial intensive therapy, elbow range of motion improved by an average of 56°, and 7 of the 8 patients reached a functional motion arc of 100°. Subsequently, following ulnar nerve surgery with or without elbow release, motion improved by an average of 22°, and 5 of the 8 patients demonstrated improvement from this intervention. Surgery led to improvements in subjective outcomes with an improvement in PROMIS mobility scores by an average of 9 points, pain interference by 6 points, and upper extremity scores by 3 points. Based on a previously determined minimally important difference of three points, these indicate significant clinical improvements. CONCLUSIONS: A subset of pediatric patients with persistent stiffness following medial epicondyle fractures may benefit from additional interventions, including intensive therapy, transposition of the ulnar nerve, and open capsular release. However, not all patients were improved after ulnar nerve surgery, and the identification and treatment of ulnar nerve irritability may not fully resolve preoperative symptoms in all patients. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV

Managing the Tensions of Essentialism: Purity and Impurity

This article proposes a new interpretation of Pierre Bourdieu, as a theorist of purity and impurity. Bourdieu’s writings indicate that through the adjudication of things or people as relatively impure or pure an image is constructed of their essential truth. Building from Bourdieu, we will show how themes of purity and impurity can be used to manage the tensions associated with attempts to impute an essence to human nature or to reality, ensuring that the moral and epistemological significance of complexity is masked. This is the reason why themes of purity and impurity so often attend polarized world views, and why they are frequently mobilized for justifying and operating biopolitical processes of social stratification and regulation