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Extraction of incarcerated medial epicondyle from the elbow joint using conventional nerve stimulator: a case report.

Dorman S, Sripada S, Clift BA, Jariwala A - J Med Case Rep (2014)

Bottom Line: We describe a simple technique of closed reduction using a conventional nerve stimulator to extract an incarcerated medial epicondyle in a 13-year-old Caucasian boy.This technique uses contraction of the attached common flexor muscles to indirectly extract the trapped medial epicondyle.We would recommend this technique where closed reduction methods have failed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Trauma and Orthopaedics, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK. ajariwala@dundee.ac.uk.

ABSTRACT

Introduction: Incarceration of the medial epicondyle is a well-recognised sequelae following closed reduction of the elbow. Manipulation for extraction is not usually successful and hence an incarcerated medial epicondyle is usually an indication for open reduction and fixation.

Case presentation: We describe a simple technique of closed reduction using a conventional nerve stimulator to extract an incarcerated medial epicondyle in a 13-year-old Caucasian boy. This technique uses contraction of the attached common flexor muscles to indirectly extract the trapped medial epicondyle.

Conclusions: This is a simple technique using a commonly available nerve stimulator and may obviate the need for extensile open reduction for extraction of the incarcerated medial epicondyle. We would recommend this technique where closed reduction methods have failed.

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Image intensifier demonstrating medial epicondyle extraction with nerve stimulator.
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Figure 2: Image intensifier demonstrating medial epicondyle extraction with nerve stimulator.

Mentions: A 13-year-old Caucasian boy presented with a left elbow dislocation to our Accident and Emergency department. Postreduction radiographs demonstrated an incarcerated ME in his joint and hence he was taken to theatre for further management (Figure 1A and 1B).Attempted closed extraction of the ME with valgus stress on his supinated forearm with dorsiflexion of his wrist failed. Hence the described technique was used with electrodes attached to the common flexor muscle mass on the medial aspect of his forearm. A summated and continuous stimulus was given using a commonly available nerve stimulator (Stimuplex® nerve stimulator, Braun). This resulted in a sudden significant contraction of his flexor group of muscles leading to the extraction of ME (Figure 2). After extraction the ME was still found to be displaced more than 5mm and therefore it was internally fixed using a cannulated screw.


Extraction of incarcerated medial epicondyle from the elbow joint using conventional nerve stimulator: a case report.

Dorman S, Sripada S, Clift BA, Jariwala A - J Med Case Rep (2014)

Image intensifier demonstrating medial epicondyle extraction with nerve stimulator.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4196202&req=5

Figure 2: Image intensifier demonstrating medial epicondyle extraction with nerve stimulator.
Mentions: A 13-year-old Caucasian boy presented with a left elbow dislocation to our Accident and Emergency department. Postreduction radiographs demonstrated an incarcerated ME in his joint and hence he was taken to theatre for further management (Figure 1A and 1B).Attempted closed extraction of the ME with valgus stress on his supinated forearm with dorsiflexion of his wrist failed. Hence the described technique was used with electrodes attached to the common flexor muscle mass on the medial aspect of his forearm. A summated and continuous stimulus was given using a commonly available nerve stimulator (Stimuplex® nerve stimulator, Braun). This resulted in a sudden significant contraction of his flexor group of muscles leading to the extraction of ME (Figure 2). After extraction the ME was still found to be displaced more than 5mm and therefore it was internally fixed using a cannulated screw.

Bottom Line: We describe a simple technique of closed reduction using a conventional nerve stimulator to extract an incarcerated medial epicondyle in a 13-year-old Caucasian boy.This technique uses contraction of the attached common flexor muscles to indirectly extract the trapped medial epicondyle.We would recommend this technique where closed reduction methods have failed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Trauma and Orthopaedics, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK. ajariwala@dundee.ac.uk.

ABSTRACT

Introduction: Incarceration of the medial epicondyle is a well-recognised sequelae following closed reduction of the elbow. Manipulation for extraction is not usually successful and hence an incarcerated medial epicondyle is usually an indication for open reduction and fixation.

Case presentation: We describe a simple technique of closed reduction using a conventional nerve stimulator to extract an incarcerated medial epicondyle in a 13-year-old Caucasian boy. This technique uses contraction of the attached common flexor muscles to indirectly extract the trapped medial epicondyle.

Conclusions: This is a simple technique using a commonly available nerve stimulator and may obviate the need for extensile open reduction for extraction of the incarcerated medial epicondyle. We would recommend this technique where closed reduction methods have failed.

Show MeSH
Related in: MedlinePlus