Adolescent medial epicondyle trash lesion clinic radiological evaluation and treatment

Elbow injures in children accounts for 10% of all fractures, ranges from simple sprain to elbow fracture dislocation. Ligamentous injury accounts for 2-3% only and are mostly sports related seen in overhead athletes. Trash lesions (the radiological appearances seemed harmless) around the elbow are reported in children under 10 years which are high energy trauma with initial normal looking X-rays. These are osteochondral or physical injures presenting with soft tissue swelling without any fractures. A high index of suspicion, early additional imaging such as MRI, CT scan, ultrasound examination and aggressive surgical care are usually necessary for prompt diagnosis and successful treatment of these injuries before complications arise. We presented a case of an elbow injury in a 15 year old girl, following a fall on her outstretched hand with initial normal findings in her X-rays. 3 months following the injury she had persisting pain and instability with ulnar nerve impingement symptoms. Her elbow CT scan, nerve conduction study confirmed the avulsion fracture of medial epicondyle with ulnar nerve neuritis and cubital tunnel syndrome. Valgus stress test proved the extent of additional medial instability. Medial epicondyle avulsion fractures are always challenging for fixation. The retracting UCL forces prevents healing and were prone for failure with non-operative splinting once instability is defined. Attempted fixation can also result in failure of fixation. Our case study highlights the possibility of such trash lesion in adolescent and also the modified technique of ulnar collateral ligament (UCL) reconstruction in a cost effective manner

A displaced T type intercondylar distal humerus fracture with radial nerve palsy in a 10-year-old treated by closed reduction and K wire fixation

T type intercondylar fractures of the distal hummers in the pediatric age group is an extremely rare injury. These fractures are difficult to diagnosed as they can be mistaken for extension type injuries. The few clinal trials on the management of the fracture, it is widely regarded that the accepted method of treatment is open reduction and rigid internal fixation. It is easier to ensure stable articular reconstruction of the intra articular fragments by this method. Open reduction and internal fixation of there fractures are associated with high complication rate, which include wound site problems, non-union due to periosteal stripping, heterotrophic ossification and iatrogenic nerve injury. Large soft tissue dissection can also lead to vascular compromise and significant scar tissue which is associated with a stiff elbow. We present a case of a 10-year-old boy who sustained an intercondylar fracture with radial nerve palsy which was treated by closed reduction and Kirshner wire fixation with excellent results at 1 year follow up