Isolated intra-articular incarceration of the pediatric medial epicondyle fracture: successful open reduction and single K-wire fixation in a resource-limited setting
Rajan Kandel, Pramod Kumar Kafle, Bishwaraj AdhikariIntroduction and importance:
Medial humeral epicondyle fractures account for approximately 11–20% of pediatric elbow fractures and are frequently associated with elbow dislocation. Intra-articular incarceration of the fragment is an uncommon but clinically significant complication that constitutes an absolute indication for urgent surgical intervention. Early recognition is critical to prevent long-term sequelae such as instability, nonunion, chronic pain, and ulnar nerve dysfunction. Management may be particularly challenging in resource-limited settings where advanced imaging and specialized implants are not always available.
Case presentation:
A 12-year-old right-hand-dominant boy presented with swelling and mechanical locking of the left elbow following a fall onto an outstretched hand. Radiographs demonstrated the absence of the medial epicondyle ossification center from its anatomical location with intra-articular displacement, later confirmed by computed tomography. Open reduction and internal fixation using a single 1.6-mm Kirschner wire were performed. After 3 weeks of immobilization followed by progressive mobilization, radiographic union was achieved. At a 2-month follow-up, the patient demonstrated a full, painless range of motion with a Mayo Elbow Performance Score of 100 and no complications.
Clinical discussion:
Incarceration of the medial epicondyle fragment within the elbow joint is rare but mandates prompt operative management. Although screw fixation is commonly preferred because it provides interfragmentary compression, Kirschner wire fixation remains a viable alternative, particularly for smaller fragments or in resource-constrained environments. This case demonstrates that stable fixation, anatomical reduction, and structured rehabilitation are at times more significant determinants of outcome than implant choice alone.
Conclusion:
Isolated intra-articular incarceration of a medial epicondyle fragment should be suspected when clinical restriction of motion and radiographic incongruity coexist, even in the absence of documented dislocation. Timely open reduction combined with single K-wire fixation, whenever appropriate for the fragment size, can yield excellent union and functional outcomes. Adherence to sound surgical principles is the most important factor in effective fracture management, even with a simple implant.