case_images: PMC6476114_01
case_images: 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).
case_images: CRIOR2019-1965343.001.jpg
case_images: PMC6476114_01_CRIOR2019-1965343.001.jpg
case_images: fig1
case_images: 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).
case_images: Preoperative ultrasonography of the right elbow. Humeral avulsion of the LCL was clearly confirmed.
case_images: CRIOR2019-1965343.002.jpg
case_images: PMC6476114_01_CRIOR2019-1965343.002.jpg
case_images: fig2
case_images: Proximal avulsion of LCL from the epicondyle was clearly seen in the ultrasonography (Figure 2).
case_images: 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.
case_images: CRIOR2019-1965343.003.jpg
case_images: PMC6476114_01_CRIOR2019-1965343.003.jpg
case_images: fig3
case_images: 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).
case_images: 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.
case_images: CRIOR2019-1965343.004.jpg
case_images: PMC6476114_01_CRIOR2019-1965343.004.jpg
case_images: fig4
case_images: 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).
case_images: Postoperative stress X-ray of the right elbow evaluated under anesthesia (4 months after the primary surgery). There was no difference of the instability.
case_images: CRIOR2019-1965343.005.jpg
case_images: PMC6476114_01_CRIOR2019-1965343.005.jpg
case_images: fig5
case_images: 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).