DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20220369

Adolescent medial epicondyle trash lesion clinic radiological evaluation and treatment

Navaneeth Ghantasala, Sitsabesan Chokkalingam, Shibusumanth ., Nikhilesh Nair

Abstract


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.


Keywords


Medial epicondyle trash lesion, Ulnar nerve neuritis, Cubital tunnel syndrome, Elbow instability, UCL reconstruction, Reverse docking, Palmaris longus tendon graft

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References


Waters PM, Beaty J, Elbo KJ. TRASH” (the radiographic appearance seemed harmless) lesions. J Pediatr Orthop. 2010;30(2):77-81.

Luker K, Frick SL. TRASH (the radiographic appearance seemed harmless) lesions about the elbow. Pediatric Orthopedic Trauma Case Atlas. Switzerland: Springer; 2020.

Schwab GH, Bennett JB, Woods GW, Tullos HS. Biomechanics of elbow instability: the role of the medial collateral ligament. Clin Orthop Relat Res. 1980;146:42-52.

Fleisig GS, Andrews JR, Dillman CJ, Escamilla RF. Kinetics of baseball pitching with implications about injury mechanisms. Am J Sports Med. 1995;23(2):233-9.

Biz C, Crimì A, Belluzzi E, Maschio N, Baracco R, Volpin A, et al. Conservative versus surgical management of elbow medial ulnar collateral ligament injury: a systematic review. Orthop Surg. 2019;11(6):974-84.

Ciccotti MG, Atanda A, Nazarian LN, Dodson CC, Holmes L, Cohen SB. Stress sonography of the ulnar collateral ligament of the elbow in professional baseball pitchers: a 10-year study. Am J Sports Med. 2014;42(3):544-51.

Park MC, Ahmad CS. Dynamic contributions of the flexor-pronator mass to elbow valgus stability. J Bone Joint Surg Am. 2004;86(10):2268-74.

Yuxi Su, Nan G. Treatment of medial humeral epicondyle fractures in children using absorbable self-reinforced polylactide pins. Medicine (Baltimore). 2020;99(17):19861.

Saper MG, Pierpoint LA, Liu W, Comstock RD, Polousky JD, Andrews JR. Epidemiology of shoulder and elbow injuries among United States high school baseball players: school years 2005-2006 through 2014-2015. Am J Sports Med. 2018;46(1):37-43.