今日の臨床サポート

上腕骨内側上顆骨折

著者: 田崎憲一 荻窪病院 整形外科・手の外科

監修: 落合直之 キッコーマン総合病院外科系センター

著者校正/監修レビュー済:2018/02/28
患者向け説明資料

概要・推奨   

疾患のポイント:
  1. 上腕骨内側上顆骨折とは、前腕屈筋・回内筋の起始部であり、肘関節内側側副靱帯起始部でもある上腕骨内側上顆の骨折である。
  1. 肘伸展位で転倒して、肘関節の外反強制を受け、付着する筋腱、靱帯に牽引されて内側上顆が裂離する機序が多く、肘関節の脱臼を合併することが多い理由である
  1. 脱臼例では骨片が関節内に陥入することがある。
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薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
田崎憲一 : 特に申告事項無し[2021年]
監修:落合直之 : 特に申告事項無し[2021年]

病態・疫学・診察

疾患情報(疫学・病態)  
  1. 上腕骨内側上顆は上腕骨遠位端内側(尺側)に突出する骨性隆起である。
  1. 前腕屈筋・回内筋の起始部であり、肘関節内側側副靱帯起始部でもある上腕骨内側上顆の骨折である。<図表>
  1. 骨端線閉鎖前後の小学校高学年から中学生(9~15歳)に多く発生する[1]
  1. 小児肘関節骨折の9~20%、平均10%を占めるといわれる[2]
  1. 肘伸展位で転倒して、肘関節の外反強制を受け、付着する筋腱、靱帯に牽引されて内側上顆が裂離する機序が多く、肘関節の脱臼を合併することが多い理由である。
  1. 同様の発症機転で橈骨頭頚部の骨折や肘頭不全骨折を生じるJeffery骨折に注意する[3]<図表>
  1. 肘関節脱臼に合併して発症するものが50~60%ある[4][5][6]
  1. 10歳代前半の野球肘障害として、全力投球を繰り返した結果に内側上顆の骨端離開を生じることもある(little leaguer’s elbow)[7]
  1. まれに直達外力や腕相撲などで成人にも発生する[8]
  1. 転位の大きい例では、内側の支持機構が骨片とともに遊離するため内側の動揺性が認められる[9]
問診・診察のポイント  
問診
  1. 受傷状況、疼痛発生の経過を確認する。転倒などの外傷で急に発症したものか、スポーツなどで上肢を酷使して発症したかを明らかにする。

これより先の閲覧には個人契約のトライアルまたはお申込みが必要です。

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文献 

著者: S L Case, W L Hennrikus
雑誌名: Am J Sports Med. 1997 Sep-Oct;25(5):682-6.
Abstract/Text Eight adolescent athletes (average age, 11 years; range, 9 to 15) underwent open reduction and internal fixation of acute, displaced medial epicondyle fractures. Fixation was achieved with a screw and washer. Four patients (50%) had associated elbow dislocations. Elbow motion in a brace was initiated 4 days after surgery. The brace allowed full flexion and extension but protected the elbow against valgus stress. Bracing was continued for 4 weeks. The average duration of followup was 10 months (range, 6 to 13). All fractures united, and full motion was achieved in seven patients. One patient lost 5 degrees of hyperextension compared with the opposite elbow. All eight elbows were stable to valgus stress and were pain-free. All patients returned to full sports activity.

PMID 9302476  Am J Sports Med. 1997 Sep-Oct;25(5):682-6.
著者: C S Resnik
雑誌名: Radiol Clin North Am. 1989 Sep;27(5):1013-22.
Abstract/Text Because many injuries to the pediatric skeleton are unique and can present with only subtle radiographic abnormalities, familiarity with their appearance can aid in accurate diagnosis. These include physeal injuries, incomplete fractures, and avulsion injuries. Recognition of characteristic fractures also allows correct identification of a battered child. As illustrated in examples of injury to the elbow, an organized search for clues to abnormal alignment is particularly helpful in the evaluation of pediatric skeletal trauma.

PMID 2772158  Radiol Clin North Am. 1989 Sep;27(5):1013-22.
著者: C C JEFFERY
雑誌名: J Bone Joint Surg Br. 1950 Aug;32-B(3):314-24.
Abstract/Text
PMID 14778850  J Bone Joint Surg Br. 1950 Aug;32-B(3):314-24.
著者: D J MAYLAHN, J J FAHEY
雑誌名: J Am Med Assoc. 1958 Jan 18;166(3):220-8.
Abstract/Text
PMID 13491329  J Am Med Assoc. 1958 Jan 18;166(3):220-8.
著者: J V Fowles, N Slimane, M T Kassab
雑誌名: J Bone Joint Surg Br. 1990 Jan;72(1):102-4.
Abstract/Text After dislocation of the elbow with avulsion of the medial epicondyle, the management of the latter is controversial. Of 28 children followed up after initial closed reduction of the elbow, 19 had a satisfactory closed reduction of the epicondyle and were treated in plaster. At follow-up, 11 children had a normal elbow and eight had lost an average of 15 degrees of flexion. Nine children had had open reduction and internal fixation of the fragment, one for an open injury, three for displacement of the epicondyle and six for intra-articular entrapment of the fragment. Five of these children had ulnar nerve contusion or compression, four requiring anterior transposition of the nerve. At review, only three had normal elbows and six had lost an average of 37 degrees of flexion. We agree with other authors that surgery is indicated only for children in whom the epicondyle is trapped in the joint or is significantly displaced after closed reduction.

PMID 2298765  J Bone Joint Surg Br. 1990 Jan;72(1):102-4.
著者: B G BROGDON, N E CROW
雑誌名: Am J Roentgenol Radium Ther Nucl Med. 1960 Apr;83:671-5.
Abstract/Text
PMID 13804689  Am J Roentgenol Radium Ther Nucl Med. 1960 Apr;83:671-5・・・
著者: K Ogawa, M Ui
雑誌名: J Trauma. 1996 Sep;41(3):494-7.
Abstract/Text Ten cases with fracture-separation of the medial humeral epicondyle occurring during arm wrestling were studied to clarify the nature of injury and the mechanism involved. Patients were all male, aged 13 to 15 years. The following results were obtained: (1) the injury often occurred in children immediately before closure of the epiphyseal plate, (2) the injury occurred only when the arm wrestler took a posture in which his center of gravity could shift easily, (3) the injury developed only when one wrestler tried to force the end of the match and the other countered that move, and (4) no lateral instability of the elbow was observed in patients with this injury. These results suggest that the injury is caused by muscular violence. When the maximally contracted muscles attaching to the medial humeral epicondyle are suddenly and passively stretched by shifting of the patient's center of gravity and by the opposing wrestler's counterattack, a shift from concentric contraction to eccentric contraction could occur and apply a large muscle force to the medial humeral epicondyle.

PMID 8810969  J Trauma. 1996 Sep;41(3):494-7.
著者: G W Woods, H S Tullos
雑誌名: Am J Sports Med. 1977 Jan-Feb;5(1):23-30. doi: 10.1177/036354657700500105.
Abstract/Text
PMID 848632  Am J Sports Med. 1977 Jan-Feb;5(1):23-30. doi: 10.1177/・・・
著者: Eric W Edmonds
雑誌名: J Bone Joint Surg Am. 2010 Dec 1;92(17):2785-91. doi: 10.2106/JBJS.I.01637.
Abstract/Text BACKGROUND: The management of fractures of the medial humeral epicondyle is controversial, but the primary issue is the relationship of outcomes to the extent of fracture displacement. This study compares the use of radiographs and three-dimensional computed tomography for determining the amount of displacement in medial humeral epicondylar injuries deemed to be minimally displaced (<5 mm) or nondisplaced.
METHODS: A retrospective review was performed on the cases of all patients with a fracture of the medial humeral epicondyle that had been diagnosed as minimally displaced or nondisplaced who were seen over a one-year period at our institution. Measurements of medial and anterior displacement on both the radiographs and three-dimensional computed tomography scan were recorded. Measurements of displacement were also recorded on internal oblique radiographs of the elbow, if available. Demographics, treatment, and any additional findings by computed tomography scans were noted. Means and Student t tests were utilized for statistical analysis.
RESULTS: The eleven patients who met the inclusion criteria had a mean age of 12.2 years (range, 7.3 to 15.4 years). One fracture that involved the medial condyle on the computed tomography scan was excluded from the analysis. Anterior displacement was immeasurable on all but one lateral radiograph and recorded as 0 mm; the mean was 0.9 mm, which was significantly less than the anterior displacement on the three-dimensional computed tomography scan (mean, 8.8 mm; range, 0 to 15 mm) (p ≤ 0.001). Conversely, mean medial displacement on anteroposterior radiographs was 3.5 mm (range, 0 to 8 mm), which was significantly more than that measured on three-dimensional computed tomography scans (mean, 0.3 mm; range, 0 to 1.9 mm) (p ≤ 0.001). Mean displacement on internal oblique radiographs of the elbow was 6.6 mm (range, 0 to 10.5 mm) and matched the anterior displacement measurement on the three-dimensional computed tomography scan in three of the six patients (p = 0.037). Five of the six fractures with >1 cm of displacement by three-dimensional computed tomography scan underwent surgical treatment.
CONCLUSIONS: Standard radiographs (anteroposterior and lateral views) are not sufficient to measure anterior displacement nor accurate enough to measure medial displacement of medial humeral epicondylar fractures. Internal oblique radiographs of the elbow appear to approximate the true anterior displacement, but three-dimensional computed tomography is the most accurate method to assess true displacement. The results of this study demonstrate that fractures that are found to be minimally displaced or nondisplaced by radiographs may have >1 cm of anterior displacement, for which surgery is usually recommended.

PMID 21123608  J Bone Joint Surg Am. 2010 Dec 1;92(17):2785-91. doi: 1・・・
著者: Djamel M Louahem, Sophie Bourelle, Florent Buscayret, Philippe Mazeau, Paula Kelly, Alain Dimeglio, Jérôme Cottalorda
雑誌名: Arch Orthop Trauma Surg. 2010 May;130(5):649-55. doi: 10.1007/s00402-009-1009-3. Epub 2009 Dec 4.
Abstract/Text BACKGROUND: Elbow instability is a common feature after medial epicondyle fractures, displaced or not, even in the absence of dislocation. Undisplaced or minimally displaced fractures often have an underestimated degree of instability secondary to unrecognised capsuloligamentous and muscular injuries. The purpose of this retrospective study was to analyze and to assess objectively the results of the surgical treatment of these acute injuries.
METHODS: One hundred and thirty-nine displaced medial epicondyle fractures were surgically treated and reviewed. A valgus stress test was performed on each child under general anesthesia or sedation. Functional outcome was assessed using a scoring system based on a series of clinical and radiographic criteria. The mean age of patients at the time of accident was 11.9 years. Mean follow-up was 3.9 years. All fractures had associated with instability of the elbow. A posterolateral elbow dislocation was associated in 80 fractures. The medial epicondylar fragment was anatomically reduced and fixed in all cases.
RESULTS: The final result was excellent in 130 cases and good in 9 cases. Elbow were stable and pain free in all patients. Normal elbow range of motion was reported in 133 cases. Union was achieved in all cases. Among these cases, nine had presented a union with no change on valgus stress views. No cases of cubitus valgus >/=10 degrees were observed. Anatomical abnormalities of the elbow were present in 28 cases: periarticular calcification in 18 cases, medial condyle groove formation in 4 cases, moderate hypertrophy and fragmentation of the medial epicondyle, respectively, in 3 cases. The positive valgus stress test performed at the time of surgery for all epicondyle fractures without associated dislocation regardless of there degree of displacement justified our operative approach.
CONCLUSION: Operative intervention is a good management of these fractures and results in an anatomic reduction, a solid bone union and prevents valgus instability. Even with postoperative immobilization of the elbow (mean of 4 weeks), stiffness is rare. Damage to the medial stabilizing structure of the elbow rather than the extent of medial epicondyle displacement has a far greater influence on joint stability and outcome.

PMID 19960347  Arch Orthop Trauma Surg. 2010 May;130(5):649-55. doi: 1・・・
著者: R F Hines, W A Herndon, J P Evans
雑誌名: Clin Orthop Relat Res. 1987 Oct;(223):170-4.
Abstract/Text Thirty-one patients with fractures of the medial epicondyle displaced more than 2 mm were evaluated an average of four years after their injury. Twenty-three patients had good results regardless of the degree of displacement or the presence of an elbow dislocation. One patient, had a poor result due to a technical error in pin placement. The remaining seven patients had the fracture fragment trapped in the joint and did worse, with three poor results. There was no correlation between range of motion and degree of displacement, length of immobilization, time from injury to surgery, presence of a dislocation, or open versus percutaneous treatment. Operative treatment of medial epicondyle fractures displaced greater than 2 mm gave consistently good results with a good range of motion, good stability, no ulnar nerve symptoms, and no deformity.

PMID 3652571  Clin Orthop Relat Res. 1987 Oct;(223):170-4.
著者: F M SMITH
雑誌名: J Am Med Assoc. 1950 Feb 11;142(6):396-402, illust.
Abstract/Text
PMID 15402381  J Am Med Assoc. 1950 Feb 11;142(6):396-402, illust.
著者: Atul F Kamath, Keith Baldwin, John Horneff, Harish S Hosalkar
雑誌名: J Child Orthop. 2009 Oct;3(5):345-57. doi: 10.1007/s11832-009-0192-7. Epub 2009 Aug 15.
Abstract/Text PURPOSE: There is ongoing debate about the management of medial epicondyle fractures in the pediatric population. This systematic review evaluated non-operative versus operative treatment of medial epicondyle fractures in pediatric and adolescent patients over the last six decades.
METHODS: A systematic review of the available literature was performed. Frequency-weighted mean union times were used to compare union rates for closed versus open treatments. Moreover, functional outcomes and range-of-motion variables were correlated with varying treatment modalities. Any complications, including ulnar nerve symptoms, pain, instability, infection, and residual deformity, were cataloged.
RESULTS: Fourteen studies, encompassing 498 patients, met the inclusion/exclusion criteria. There were 261 males and 132 female patients; the frequency-weighted average age was 11.93 years. The follow-up range was 6-216 months. Under the cumulative random effects model, the odds of union with operative fixation was 9.33 times the odds of union with non-operative treatment (P < 0.0001). There was no significant difference between operative and non-operative treatments in terms of pain at final follow-up (P = 0.73) or ulnar nerve symptoms (P = 0.412).
CONCLUSIONS: Operative treatment affords a significantly higher union rate over the non-operative management of medial epicondyle fractures. There was no difference in pain at final follow-up between operative and non-operative treatments. As surgical indications evolve, and the functional demands of pediatric patients increase, surgical fixation should be strongly considered to achieve stable fixation and bony union.

PMID 19685254  J Child Orthop. 2009 Oct;3(5):345-57. doi: 10.1007/s118・・・
著者: P O Josefsson, L G Danielsson
雑誌名: Acta Orthop Scand. 1986 Aug;57(4):313-5.
Abstract/Text Fifty-six conservatively treated children (7-17 years) with a displaced (1-15 mm) fracture of the medial humeral epicondyle were examined 35 (21-48) years after the injury. In 31 cases a pseudarthrosis had developed of which 3 had mild ulnar nerve symptoms. The function and range of motion of the elbow was good in all cases.

PMID 3788492  Acta Orthop Scand. 1986 Aug;57(4):313-5.
著者: N I Wilson, R Ingram, L Rymaszewski, J H Miller
雑誌名: Injury. 1988 Sep;19(5):342-4.
Abstract/Text Forty-three children with a fracture of the medial epicondyle were reviewed; 20 had had non-operative treatment and 23 had been treated by operation. Any final disability was slight, irrespective of the treatment used. Although surgery was more likely to restore the fragment to its normal position (P = 0.0001) and achieve bony union (P = 0.04), minor symptoms were less common in the non-operatively treated group (P = 0.02). Instability of the elbow could not be demonstrated in any of the patients. It is recommended that operative treatment is employed only when an intra-articular fragment cannot be removed from the joint by manipulation.

PMID 3255715  Injury. 1988 Sep;19(5):342-4.
著者: Nor Hazla Mohamed Haflah, Sharaf Ibrahim, Jamari Sapuan, Shalimar Abdullah
雑誌名: J Pediatr Orthop B. 2010 Sep;19(5):459-61. doi: 10.1097/BPB.0b013e32833b6032.
Abstract/Text Elbow dislocations associated with a medial epicondyle fracture and ulnar nerve palsy are uncommon injuries. We present the case of an 11-year-old girl with an elbow dislocation treated by closed manual reduction. The medial epicondyle fracture was missed initially until she developed an ulnar nerve palsy 2 months later. Intraoperatively we discovered the bony epicondyle piercing the joint capsule and compressing the ulnar nerve. Removal of the bony fragment relieved her symptoms and she returned to normal activities at 1 year follow-up. We would like to highlight this rare occurrence and present the detailed history and management of this case.

PMID 20555271  J Pediatr Orthop B. 2010 Sep;19(5):459-61. doi: 10.1097・・・
著者: J Todd R Lawrence, Neeraj M Patel, Jonathan Macknin, John M Flynn, Danielle Cameron, Hayley C Wolfgruber, Theodore J Ganley
雑誌名: Am J Sports Med. 2013 May;41(5):1152-7. doi: 10.1177/0363546513480797. Epub 2013 Mar 18.
Abstract/Text BACKGROUND: The optimal treatment of medial epicondyle fractures in pediatric athletes remains unclear.
PURPOSE: To evaluate the outcomes of operative and nonoperative management of medial epicondyle fractures in young athletes.
STUDY DESIGN: Case series; Level of evidence, 4.
METHODS: The records of all children with fractures of the medial epicondyle over a 5-year period, with a minimum 2 years of follow-up at a pediatric tertiary referral center, were reviewed. Patients with intra-articular entrapment of the fracture fragment or ulnar nerve entrapment were excluded. Treatment decisions were made primarily based on injury mechanism and elbow laxity or instability. Patients were contacted and asked to complete a modified Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.
RESULTS: Complete data with 2-year follow-up were available for 20 athletes: 6 treated nonoperatively and 14 treated operatively. At the latest follow-up, both groups achieved excellent DASH scores. Half of each cohort required physical therapy, and 6 of 14 patients who received operative treatment reported numbness. All patients were either very or completely satisfied with their treatment. Fourteen patients were overhead athletes (8 treated operatively, 6 nonoperatively). Excellent DASH scores were achieved in both groups, and all overhead athletes were able to return to their sport at the next appropriate level. Seven patients were baseball pitchers and sustained a fracture while throwing (4 treated operatively, 3 nonoperatively). None felt their performance was limited after treatment, and excellent DASH scores were achieved in both groups.
CONCLUSION: These data demonstrate that nonoperative treatment can be successful in young athletes with low-energy medial epicondyle avulsions, a stable elbow, and minimal fracture displacement. Surgical management can be successful in athletes who sustain more significant trauma, who have elbow laxity or instability, or who have significant fracture fragment displacement after a fracture of the medial epicondyle.

PMID 23507792  Am J Sports Med. 2013 May;41(5):1152-7. doi: 10.1177/03・・・
著者: Jeremy T Smith, Eric D McFeely, Donald S Bae, Peter M Waters, Lyle J Micheli, Mininder S Kocher
雑誌名: J Pediatr Orthop. 2010 Oct-Nov;30(7):644-8. doi: 10.1097/BPO.0b013e3181ed4381.
Abstract/Text BACKGROUND: There is little information regarding the clinical presentation and/or surgical treatment of symptomatic medial humeral epicondyle nonunions. The purpose of this investigation was to describe the presenting symptoms and evaluate the results of surgical fixation of medial epicondyle nonunions.
METHODS: Eight patients with symptomatic medial humeral epicondyle nonunions were evaluated after open reduction and internal fixation of the medial epicondyle. Average age at the time of initial injury was 11.3 years (range: 9.2 to 13.9 y). Outcome was assessed with radiographs and a questionnaire that included 3 self-reported functional outcome tools at a mean of 4.7 years (range: 1.5 to 7.5 y) after the surgery.
RESULTS: Common presenting symptoms and signs included medial elbow pain and prominence, pain with lifting weights or throwing, limited range of motion, valgus instability, and ulnar nerve compression. After open reduction and internal fixation, patients reported improved pain score from a mean of 6.2 to 0.5. All patients returned to athletics. Mean postoperative QuickDASH (Disability of Arm, Shoulder, and Hand) score (and SD) was 6.8 ± 11.7; mean Mayo Elbow Performance Score was 85.8 ± 14.6; and mean Timmerman-Andrews Elbow Score was 87.5 ± 10.4. Radiographic union was achieved in all but one patient postoperatively and there were no operative complications.
CONCLUSIONS: Open reduction and internal fixation of symptomatic medial humeral epicondyle nonunion results in improved pain and good elbow function.
LEVEL OF EVIDENCE: Retrospective Case Series. Therapeutic Level IV.

PMID 20864846  J Pediatr Orthop. 2010 Oct-Nov;30(7):644-8. doi: 10.109・・・
著者: Mehmet Erdil, Kerem Bilsel, Ali Ersen, Mehmet Elmadag, Nejat Tuncer, Cengiz Sen
雑誌名: Int J Surg Case Rep. 2012;3(9):467-70. doi: 10.1016/j.ijscr.2012.04.021. Epub 2012 May 29.
Abstract/Text INTRODUCTION: Symptomatic nonunion of humeral medial epicondyle can be problematic and difficult to treat due to high complication rates related to open reduction and internal fixation methods.
PRESENTATION OF CASE: We described four patients with symptomatic medial humeral epicondyle nonunion who underwent open reduction and internal fixation.
DISCUSSION: Symptomatic nonunion of humeral medial epicondyle is a rare entity. Surgical technique can be difficult because of anatomical and biomechanical factors. In the literature, there are a few cases of humeral medial epicondyle treated by open reduction and internal fixation.
CONCLUSION: Open reduction and internally fixation of the medial epicondyle nonunion with one cannulated screw results with improved elbow function.

Copyright © 2012. Published by Elsevier Ltd.
PMID 22743011  Int J Surg Case Rep. 2012;3(9):467-70. doi: 10.1016/j.i・・・
著者: Sanjai K Shukla, Mark S Cohen
雑誌名: J Shoulder Elbow Surg. 2011 Apr;20(3):455-60. doi: 10.1016/j.jse.2010.12.017.
Abstract/Text HYPOTHESIS: Nonunion of the medial epicondyle can cause symptoms of pain and instability in certain high-demand individuals. Problems with open reduction and internal fixation (ORIF) have led some to recommend excision of the nonunited fragment, followed by soft tissue repair. This study tests the hypothesis that patients with symptomatic nonunion of the medial epicondyle can be successfully treated with ORIF using a tension band construct.
METHODS: Five male patients were identified who underwent ORIF of a chronic, nonunited medial epicondyle fracture. Patients were a mean age of 15.8 years at presentation. The time since the original injury averaged 24 months.
RESULTS: At an average follow-up of 31 months, all patients reported satisfaction with their surgery. All nonunions healed, and the average postoperative extension improved significantly compared with preoperative values (P < .05). Disabilities of Arm, Shoulder and Hand scores were low (mean, 0.8) and Mayo Elbow Performance scores were high (mean, 100) at follow-up. No patient complained of prominent hardware or ulnar nerve irritation. All patients were able to return to high levels of physical activity, including one who qualified for the US Marine Corps.
DISCUSSION: Nonunion of the medial epicondyle can be symptomatic in certain high loading individuals. Surgical repair of the united fragment is difficult due to anatomical and biomechanical factors.
CONCLUSION: We believe that ORIF of chronic medial epicondyle nonunions using a tension band construct is a viable option in the symptomatic, high-demand patient.

Copyright © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.
PMID 21397795  J Shoulder Elbow Surg. 2011 Apr;20(3):455-60. doi: 10.1・・・
著者: Yasunori Kaneshiro, Noriaki Hidaka, Koichi Yano, Makoto Fukuda, Hideki Sakanaka
雑誌名: J Hand Surg Asian Pac Vol. 2017 Mar;22(1):70-74. doi: 10.1142/S0218810417500125.
Abstract/Text BACKGROUND: The medial epicondyle nonunion becomes symptomatic valgus instability with medial elbow pain and joint instability due to dysfunction of the medial collateral ligament (MCL), thus requiring surgical treatment. The purpose of the present study is to report the clinical result of the fragment excision and ligament reconstruction by free tendon graft in the treatment of symptomatic medial epicondyle nonunion.
METHODS: A retrospective study of five consecutive patients was performed. All five patients had signs and symptoms of valgus instability of the elbow. The mean period of nonunion was 25 years, and their injuries progressed asymptomatically until symptoms developed in adulthood after a second injury.
RESULTS: All patients were treated by fragment excision and MCL reconstruction. At the final follow-up, no patients exhibited pain or instability. The mean joint range of motion was 0o of extension and 138o of flexion, with an MEPS of 100 points in all patients.
CONCLUSIONS: By ligament reconstruction for MCL insufficiency and removing the bone fragments avoided irritation by the bone fragments, pain and instability disappeared, good range of motion was restored, and excellent outcomes were achieved in all patients. We believe that fragment excision and MCL reconstruction should be considered as the treatment option for symptomatic medial epicondyle nonunion of the humerus.

PMID 28205469  J Hand Surg Asian Pac Vol. 2017 Mar;22(1):70-74. doi: 1・・・
著者: Raymond E Anakwe, Adam C Watts, Jane E McEachan
雑誌名: J Pediatr Orthop B. 2010 May;19(3):239-41. doi: 10.1097/BPB.0b013e3283353d12.
Abstract/Text We present two cases of patients with delayed ulnar nerve palsies after operative fixation of displaced medial epicondyle fractures. These fractures are common childhood injuries and the optimal management for the ulnar nerve is not universally agreed. The ulnar nerve is at risk of compression distal to the elbow and where surgical decompression is selected, care must be taken to ensure that this is complete.

PMID 20093953  J Pediatr Orthop B. 2010 May;19(3):239-41. doi: 10.1097・・・
著者: David M Marcu, Joshua Balts, James J McCarthy, Scott H Kozin, Kenneth J Noonan
雑誌名: J Pediatr Orthop. 2011 Mar;31(2):e13-6. doi: 10.1097/BPO.0b013e318209287d.
Abstract/Text UNLABELLED: Surgical treatment for medial epicondylar fractures is controversial, and indications depend on variety of variables, including the degree of displacement and future goals of the patient. If surgery is to be performed, typically open reduction of the medial epicondylar fragment, with visualization of the ulnar nerve, and fixation is undertaken. Pins, screws, and cannulated screws have all been described for fixation. The use of cannulated screw systems, especially when coupled with fluoroscopy, has many advantages, and is generally considered a safe way to place a screw accurately while minimizing the surgical exposure. Unfortunately, there are also inherent risks with a cannulated screw system that often go unrecognized, such as guide pin bending, breakage or unrecognized advancement. The complications are rarely reported, and recognition is critical to avoid future complications. This is the first study to report a radial nerve injury after the use of cannulated screw systems in 2 patients with a pediatric medial epicondyle fracture fixation. This study highlights the danger of these systems for this fracture fixation, and we discuss the potential techniques to avoid this complication. Our purpose in publishing this series of cases is to shed light on a complication, in the hope that its exposure will help prevent such complications in the future.
LEVEL OF EVIDENCE: IV, Case Series.

PMID 21307699  J Pediatr Orthop. 2011 Mar;31(2):e13-6. doi: 10.1097/BP・・・
著者: Dave Simon, Julio Javier Masquijo, Mary Jean Duncan, Ken Kontio
雑誌名: J Pediatr Orthop. 2010 Mar;30(2):125-9. doi: 10.1097/BPO.0b013e3181cf3bfd.
Abstract/Text UNLABELLED: Intra-articular incarceration of the median nerve after closed reduction of an elbow dislocation is a rare and potentially devastating complication. We report the case of a 4-year-old boy who had an entrapment of the median nerve after spontaneous reduction of a posterior dislocation. All the cases previously reported in the literature are reviewed. The diagnostic algorithm and treatment options are discussed. This is the only case in the literature in which spontaneous reduction of the dislocation occurred before medical evaluation. This scenario can occur in children as young as 4 years of age. Although incarceration of the median nerve after an elbow dislocation is an uncommon complication, it must be recognized early and explored to prevent permanent disability.
LEVEL OF EVIDENCE: Level IV.

PMID 20179558  J Pediatr Orthop. 2010 Mar;30(2):125-9. doi: 10.1097/BP・・・
著者: Michael P Glotzbecker, Benjamin Shore, Travis Matheney, Meryl Gold, Daniel Hedequist
雑誌名: J Child Orthop. 2012 Jun;6(2):105-9. doi: 10.1007/s11832-012-0395-1. Epub 2012 Mar 17.
Abstract/Text PURPOSE: To describe an alternative positioning technique for the fixation of pediatric medial epicondyle fractures which offers some significant advantages over traditional supine positioning.
METHODS: At our institution, 27 patients with a displaced medial epicondyle fracture requiring open reduction and fixation were positioned prone for the procedure. The internally rotated operative arm lies on the hand table with the elbow in a natural flexed, pronated position. The elbow can be brought into extension and flexion for appropriate intraoperative radiographs. The fracture is then reduced with the arm in flexion and pronation, without having to pull excessively on the fragment. After reduction, the fragment is held easily in place for surgical fixation. A similar group of patients from the same time period positioned supine was also examined and compared to the patients who had the surgery prone.
RESULTS: The average age of the 27 patients was 11.2 years (range 5.1-16.9 years). Indications for operative treatment were displaced medial epicondyle fracture (14), medial epicondyle fracture with associated elbow dislocation (12), and medial epicondyle fracture with ulnar nerve symptoms (1). At a mean of 4.5 months of follow up (1-11 months), 7 patients required the removal of hardware for screw irritation. There were no infections in the 27 surgeries and there were no other intraoperative or postoperative complications. Mild loss of flexion and extension was common in the group. Patients who had surgery in the supine position were similar with regards to patient demographics and postoperative complications, including the need for screw removal.
CONCLUSIONS: While displaced medial epicondyle fractures can be treated successfully with traditional positioning, placing patients prone for the fixation of pediatric medial epicondyle fractures offers some significant advantages over supine positioning.

PMID 23730340  J Child Orthop. 2012 Jun;6(2):105-9. doi: 10.1007/s1183・・・
著者: W B Bede, A R Lefebvre, M A Rosman
雑誌名: Can J Surg. 1975 Mar;18(2):137-42.
Abstract/Text A review of 50 children with fractures of the medial humeral epicondyle facilitated a simple classification of this injury and its management. The "apparent isolated" fracture of the medial humeral epicondyle is uncommon; it is more frequently associated with elbow dislocation, with or without spontaneous reduction, at the time of injury. Analysis of the results of treatment of medial humeral epicondylar fractures in this group of children showed that, in the case of those with an "apparent isolated" injury, treatment with a sling only gave good results in 90% whereas poorer results followed open treatment or fractures associated with dislocation. Closed treatment is therefore recommended. Open reduction is indicated only with (a) ulnar neuritis at the time of injury or (b) intra-articular fragment.

PMID 1116051  Can J Surg. 1975 Mar;18(2):137-42.

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