PMC6476114_01
Preoperative X-ray (a, b) and CT (c, d) of the right elbow. (a) AP view. (b) Lateral view. (c) Coronal plane. (d) Axial plane. Thin bony fragment of the lateral epicondyle (arrow) was observed in (c) and (d).
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fig1
In plain X-ray and CT scan of the elbow, apparent displaced medial epicondyle fracture (Watson-Jones classification type 2) together with an avulsed thin fragment of the lateral epicondyle was detected; however, no proximal radial fracture or a coronoid fracture was observed (Figure 1).
Preoperative ultrasonography of the right elbow. Humeral avulsion of the LCL was clearly confirmed.
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fig2
Proximal avulsion of LCL from the epicondyle was clearly seen in the ultrasonography (Figure 2).
Preoperative stress X-ray of the bilateral elbow evaluated under anesthesia. (a) Valgus. (b) Varus. (R: right elbow, L: left elbow.) The side-to-side differences of the joint space widening were significantly worse in the right elbow.
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fig3
The side-to-side differences of the joint space widening were 8 mm in the valgus stress and 3 mm in the varus stress, which were significantly worse in the right elbow (Figure 3).
Intraoperative photos. Upper: cranial, lower: caudal. H: humerus; R: radius. (a) Humeral avulsion of the LCL (arrow: foot print, arrow head: LCL complex). (b) Suture preparation. (c) After repair.
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fig4
After refreshing the stump of the ligament and footprint, 3 suture anchors (phi1.4 mm JuggerKnot , Zimmer Biomet, Warsaw, IN, US) were inserted into the footprint and LCL complex was sutured by double row fixation technique (Figure 4).
Postoperative stress X-ray of the right elbow evaluated under anesthesia (4 months after the primary surgery). There was no difference of the instability.
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fig5
At that time, the medial epicondyle fracture was united, and side-to-side differences of the joint space widening were 2 mm in the valgus stress and 1 mm in the varus stress, which had significantly improved compared with the previous findings (Figure 5).