A new operation for reconstruction of the femoral neck.

THE JOURNAL OF BONE AND JOINT SURGERY after avulsion of the common flexor origin from the epicondyle and severe soft-tissue disruption has been described (Mains and Freeark 1975; Wilmshurst, Millner and Batchelor 1989). In a fracture, the nerve retains its relationship to the epicondylar and ulnar heads of pronator teres and passes back through the fracture site. It may produce a gap or groove in the callus as the fracture heals called Matev’s sign (Matev 1976), as seen in this case. Three types of entrapment of the median nerve have been described after elbow dislocation (Ha!lett 1981). In one the nerve passes into the joint as above; in another it remains in the fracture site and develops a bony tunnel as the fracture heals; and in the third, not associated with fracture, the nerve is stretched and loops backwards into the joint. In the case which we describe the nerve had passed through the fracture to !ie behind the epicondyle, but had not slid into the joint or remained within the fracture site. The initial traction injury had not therefore been made worse by crushing the nerve in the joint. We have described a fourth mechanism of entrapment of the median nerve at the elbow after posterolateral elbow dislocation which may have a more favourable prognosis. The result in this case is better than would have been expected after excision and grafting of the damaged segment.