Medial to lateral diagonal injury of the elbow without elbow dislocation in children

TL;DR

This study examines a rare type of elbow fracture in children and finds that surgery leads to good recovery outcomes.

Contribution

The paper identifies clinical features and treatment outcomes for a rare medial-to-lateral diagonal elbow fracture in children without dislocation.

Findings

Surgical treatment of MELAINE fractures in children resulted in excellent or good outcomes in 100% of cases.

MELAINE fractures often involve significant medial epicondyle displacement but can be effectively managed surgically.

Abstract

The incidence of medial to lateral diagonal elbow injury (MELAINE) in children without dislocation is relatively low. This article explores the clinical characteristics and treatment outcomes of this fracture type.

A retrospective analysis of elbow fracture was performed in Dalian Women and Children's Medical Center (Group) and Shanxi Provincial Children's Hospital, between January 2019 and January 2025. The collected data encompassed patient age, gender, side, diagnose. Additional parameters included the injury mechanism, elbow joint range of motion, and radiological findings. We also recorded the carrying angle (CA), Elbow Performance Scale (EPS) score, treatment method, healing time, and complications.

The study included 21 patients (2.21%, 21/949), mean age 9.4 ± 3.08 years (range 8–14 years); 14 males and 7 females, 13 left and 8 right, from injury to surgery was 3.1 days (range 1–11 days), and the mean follow-up duration was 11.46 ± 1.73 months (range 6–37 months). 8 extension-type and 13 flexion-type. All patients underwent open reduction and internal fixation, performed via a medial approach in 19 cases, a lateral approach in 10 cases, and a combined medial and lateral approach in 8 cases. At final follow-up, the mean elbow flexion–extension and forearm pronation–supination arcs on the fractured side were 139.2° ± 9.4°, 4.5° ± 3.4°, 75.8° ± 8.1°, and 79.6° ± 8.2°, respectively, showing no significant difference from the healthy side (p > 0.05). The carrying angle on the injured side measured 14.3° ± 2.8°, respectively, compared to 15.1° ± 1.7° on the healthy side (p = 1.78). According to the EPS rating, most patients achieved an “excellent” (n = 18, 85.7%) or “good” (n = 3, 14.3%) outcome.

In older children and adolescents, medial-to-lateral diagonal elbow fractures without dislocation may be missed. The fractures frequently involve significant displacement of the medial epicondyle, yet surgical intervention can often achieve favorable clinical outcomes.

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