PMC6875267_01
Gartland type III SCHF.
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fig1
Radiographic examination of the elbow revealed a Gartland type III SCHF with posterolateral displacement (Figure 1).
Lateral percutaneous pinning: front and side view.
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Closed reduction of the fracture and its fixation by percutaneous lateral pinning were urgently performed (Figure 2).
Complete remodeling of the distal end of the humerus: 6 months postoperatively:front and side view.
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fig3
Total remodeling of the distal humeral end was radiologically noticed six months later (Figure 3).
T1 MRI sequence showing median nerve entrapment upstream of the bone callus (white arrow).
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MRI confirmed the entrapment of the median nerve within the callus (Figures 4 and 5) with signs of nervous suffering as hypertrophy (0.5 cm of diameter against 0.2 cm at the same location on the contralateral side), hypersignal on DP fat sat sequences, and amyotrophy of the flexor, pronator quadratus, and pronator teres muscles.
T2 DPFS MRI sequence showing hypertrophy (white arrow) and median nerve entrapment within the consolidated fracture.
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fig5
MRI confirmed the entrapment of the median nerve within the callus (Figures 4 and 5) with signs of nervous suffering as hypertrophy (0.5 cm of diameter against 0.2 cm at the same location on the contralateral side), hypersignal on DP fat sat sequences, and amyotrophy of the flexor, pronator quadratus, and pronator teres muscles.
Entrapment of the hypertrophic proximal end of the median nerve (white arrow) within the consolidated fracture (black arrow) and fibrosis with atrophy of the distal end of the median nerve (blue arrow).
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Its atrophic distal end was sheathed within a fibrosis facing the callus along a 1.5 cm section (Figure 6).
Post resection view flush of the bone callus of the proximal end (black arrow) and of the atrophic fibrosis part along a 1.5 cm section next to the distal end (white arrow) of the median nerve.
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fig7
The resected proximal end at the level of the callus and the regulation of the distal end by excision of all atrophic segment allowed for direct end-to-end suture, added to biological glue; the elbow was flexed at 60  to protect the suture from any tension (Figures 7 and 8).
Terminoterminal direct type suture of the median nerve (black arrow) reinforced with biological sealant (white arrow).
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fig8
The resected proximal end at the level of the callus and the regulation of the distal end by excision of all atrophic segment allowed for direct end-to-end suture, added to biological glue; the elbow was flexed at 60  to protect the suture from any tension (Figures 7 and 8).