title: Intraosseous median nerve entrapment following pediatric posterior elbow dislocation.
abstract: Intra-articular entrapment of the median nerve following reduction of a pediatric posterior elbow dislocation is a rare complication but has been reported in the literature.This article describes a case of a 7-year-old girl who sustained a posterior elbow dislocation associated with a medial epicondyle fracture and the subsequent intraosseous entrapment of her median nerve. The entrapment is believed to have resulted from new bone formation over the nerve that went unrecognized for nearly 2 years following injury. Routine imaging studies failed to detect the entrapment prior to exploratory surgery. Intra-articular entrapment of the median nerve must be suspected following pediatric elbow dislocation when concentric reduction fails, postreduction images demonstrate joint widening, or the patient has persistent clinical symptoms. This case demonstrates the potential for delay in diagnosis of the cause for neurological impairment following a relatively common injury in the pediatric population.Objective intraoperative findings and intraoperative micropathology aided in limiting the amount of nerve resected to nonviable portions. Our case demonstrates the potential use of a cable nerve graft to bridge segmental defects in peripheral nerves.
authors.affiliation: Department of Orthopaedic Surgery, Nationwide Children’s Hospital, Columbus, OH 43205-2696, USA. kenneth.bono@nationwidechildrens.org
authors.forename: Kenneth T
authors.initials: KT
authors.lastname: Bono
authors.forename: James E
authors.initials: JE
authors.lastname: Popp
mesh_terms: D002648:Child; D019299:Decompression, Surgical / Q000379:methods; D004551:Elbow Joint / Q000601:surgery; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000150:complications* / Q000601:surgery*; D008475:Median Nerve / Q000293:injuries* / Q000601:surgery*; D009408:Nerve Compression Syndromes / Q000209:etiology* / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods; D016896:Treatment Outcome; D000092464:Elbow Injuries