Epicondylar elbow fracture in children: 35-year follow-up of 56 unreduced cases

Josefsson, Per Olof; Danielsson, Lars-Göran

doi:10.3109/17453678608994399

Cited by 149 publications

(85 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Thirteen (65%) were boys and 7 (35%) were girls. Average age of children was 10.8 years (SD=2.3, range [8][9][10][11][12][13][14][15][16]. Twelve (60%) fractures were associated with an elbow dislocation out of which five cases reduced spontaneously jlmc.edu.np and remaining 15 elbows were reduced either in Emergency Department or in operating room.…”

Section: Resultsmentioning

confidence: 99%

Clinical Results of Surgically Treated Medial Humeral Epicondylar Apophyseal Avulsion Injury in Children and Adolescent.

Joshi¹,

Sundararaj²

2014

J Lumbini Med Coll

View full text Add to dashboard Cite

ABSTRACT:Introduction: Fractures of the medial humeral epicondyle represent approximately 10% of all paediatric elbow fractures. Objective of our study was to assess treatment outcomes of children and adolescent with medial epicondylar fracture of the elbow using standard operative protocols. Methods: Twenty surgically treated fractures of the medial humeral epicondyle were analysed & reviewed for their epidemiological, clinical and surgical parameters. A valgus stress test was performed under general anesthesia or sedation. All patients underwent open reduction internal fixation using a similar technique. The medial epicondylar fragment was anatomically reduced and fixed in all cases with screws, Kirshner wires or tension band wiring. At final evaluation, union (radiologically) and elbow function [MAYO elbow performance score (MEPS)] was assessed. Results: An evaluation of all of our patients after a mean follow-up of 8.75 months (SD=4.76) after initial surgery was possible. The mean age of patients at the time of injury was 10.8 years (SD=2.3). Fifteen (75%) dominant elbows were injured in our study and 12(60%) elbows had an associated elbow dislocation. On examination in operating room post anaesthesia, all of the elbow injuries revealed some degree of valgus instability. All of our patients(n=20) showed good to excellent results in the MAYO elbow performance score (MEPS). Radiographically, union was achieved in all cases. Three patients developed postoperative ulnar nerve neuropraxia, all recovered at time of final follow up. One patient developed mild lateral heterotrophic ossification but did not require any additional surgical intervention. Conclusion: Our results suggest that open reduction internal fixation of displaced medial epicondyle fractures leads to satisfactory motion and function. A valgus stress test in operating room can reveal the true nature of joint instability that can warrant operative stabilization of medial epicondylar injuries.

show abstract

Section: Resultsmentioning

confidence: 99%

Clinical Results of Surgically Treated Medial Humeral Epicondylar Apophyseal Avulsion Injury in Children and Adolescent.

Joshi¹,

Sundararaj²

2014

J Lumbini Med Coll

View full text Add to dashboard Cite

show abstract

“…Josefsson and Danielsson treated displaced fractures (1-15 mm) nonoperatively and had good results at a mean of 11 years follow up, despite demonstrating a high nonunion rate [10]. Bede et al [2] recommended nonoperative treatment based on their series of 50 patients treated operatively and nonoperatively, and only suggested operative treatment in cases where the fragment was incarcerated in the joint or when there was associated ulnar neuritis.…”

Section: Discussionmentioning

confidence: 99%

“…There is some controversy regarding the appropriate treatment in displaced fractures [1,2,[4][5][6][7][8][9][10][11][12][13][14]. Absolute indications for surgical treatment are incarceration in the joint or an elbow dislocation with ulnar nerve symptoms.…”

Section: Discussionmentioning

confidence: 99%

Alternative technique for open reduction and fixation of displaced pediatric medial epicondyle fractures

Glotzbecker

Shore

Matheney

et al. 2012

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

Purpose To describe an alternative positioning technique for the fixation of pediatric medial epicondyle fractures which offers some significant advantages over traditional supine positioning. Methods At our institution, 27 patients with a displaced medial epicondyle fracture requiring open reduction and fixation were positioned prone for the procedure. The internally rotated operative arm lies on the hand table with the elbow in a natural flexed, pronated position. The elbow can be brought into extension and flexion for appropriate intraoperative radiographs. The fracture is then reduced with the arm in flexion and pronation, without having to pull excessively on the fragment. After reduction, the fragment is held easily in place for surgical fixation. A similar group of patients from the same time period positioned supine was also examined and compared to the patients who had the surgery prone. Results The average age of the 27 patients was 11.2 years (range 5.1-16.9 years). Indications for operative treatment were displaced medial epicondyle fracture (14), medial epicondyle fracture with associated elbow dislocation (12), and medial epicondyle fracture with ulnar nerve symptoms (1). At a mean of 4.5 months of follow up (1-11 months), 7 patients required the removal of hardware for screw irritation. There were no infections in the 27 surgeries and there were no other intraoperative or postoperative complications. Mild loss of flexion and extension was common in the group. Patients who had surgery in the supine position were similar with regards to patient demographics and postoperative complications, including the need for screw removal. Conclusions While displaced medial epicondyle fractures can be treated successfully with traditional positioning, placing patients prone for the fixation of pediatric medial epicondyle fractures offers some significant advantages over supine positioning. Keywords Medial epicondyle Á Prone positioning Á Technique SummaryMedial epicondyle fractures constitute approximately 14 % of fractures involving the distal humerus and 11.5 % of all fractures in the elbow region [1][2][3]. Most often, this injury occurs in children between the ages of 9 and 14 years, with a peak incidence in the age range 11-12 years [1,4,5]. Treatment is generally nonoperative for nondisplaced or minimally displaced fractures. There is some controversy regarding the appropriate treatment in displaced fractures [1,2,[4][5][6][7][8][9][10][11][12][13][14]. Traditional descriptions of the surgical technique to fix fractures of the medial epicondyle recommend supine positioning. We describe a technique using prone positioning that offers some significant advantages when fixing these fractures.

show abstract

“…Nonunion has been reported to occur in up to 90% of displaced medial epicondyle fractures, a rate which is reduced to 7% in operatively treated patients [5]. Additionally, in elbow dislocations with associated medial epicondyle fractures, nonoperative management requires longer immobilization, which risks arthrofibrosis.…”

Section: Treatment Indicationsmentioning

confidence: 99%

Elbow Injuries in the Adolescent Thrower

Griffith

Kercher

Willimon

et al. 2018

Curr Rev Musculoskelet Med

View full text Add to dashboard Cite

Purpose of Review With an increasing rate of adolescent elbow injuries, especially in throwing athletes, the purpose of this review is to investigate the current literature regarding the diagnosis, treatment, and non-operative and operative outcomes of medial epicondyle fractures, ulnar collateral ligament repair, osteochondritis dissecans of the elbow, and olecranon stress fractures. Recent Findings Acceptable outcomes with both non-operative and operative treatments of medial epicondyle fractures have been reported, with surgical indications continuing to evolve. Unstable osteochondritis dissecans lesions, especially in patients with closed growth plates, require operative fixation, and emerging open and arthroscopic techniques including lesion debridement, marrow stimulation, autograft transfer, and allograft transplantation are described with good outcomes. Ulnar collateral repair has emerged as an exciting treatment option for an avulsion of either end of the ligament in young throwing athletes, with faster rehabilitation times than traditional ulnar collateral ligament reconstruction. Olecranon stress fractures are increasing in prevalence, and when a non-operative treatment course is unsuccessful, athletes have a high return-to-play rate after percutaneous cannulated screw placement. Summary With proper indications, non-operative and operative treatment modalities are reported with a high return-to-play and acceptable clinical outcomes for common elbow injuries, including medial epicondyle fractures, ulnar collateral ligament repair, osteochondritis dissecans of the elbow, and olecranon stress fractures, in adolescent throwing athletes. Further research is needed to better define treatment algorithms, surgical indications, and outcomes.

show abstract

Epicondylar elbow fracture in children: 35-year follow-up of 56 unreduced cases

Cited by 149 publications

References 3 publications

Clinical Results of Surgically Treated Medial Humeral Epicondylar Apophyseal Avulsion Injury in Children and Adolescent.

Clinical Results of Surgically Treated Medial Humeral Epicondylar Apophyseal Avulsion Injury in Children and Adolescent.

Alternative technique for open reduction and fixation of displaced pediatric medial epicondyle fractures

Elbow Injuries in the Adolescent Thrower

Contact Info

Product

Resources

About