Fixation of Displaced Medial Epicondyle Fractures in Adolescents

Pace, Gregory; Hennrikus, William L.

doi:10.1097/bpo.0000000000000743

Cited by 30 publications

(34 citation statements)

References 20 publications

(24 reference statements)

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“…[ 23 ] Several other authors favored the use of CLS in adolescents and KW in younger children. [ 9 , 25 ] In adolescents, CLS was our preferred choice before the BS was available at our institute. The washer is not routinely used in our hospital, and all metallic screws are offered to be removed at our institute.…”

Section: Discussionmentioning

confidence: 99%

Is bioabsorbable screw an alternative choice for displaced medial epicondylar fractures in adolescents

Rai

et al. 2020

Medicine

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In adolescent patients, cannulated lag screw (CLS) is a widely accepted choice for fixation of the medial epicondylar fracture of the humerus (MEFH). Absorbable implants, including rod, screw, and mini-plate, have been reported in children. However, to the best of our understanding, this study is the first head-to-head comparative study of CLS versus bioabsorbable screw (BS) in the treatment of MEFH. Patients of MEFH operated at our institute, from January 2010 to January 2016, were reviewed retrospectively. The patients were divided into 2 groups, the CLS group and the BS group, as per the type of implant the patient received. The CLS group consisted of 35 patients, whereas the BS group consisted of 30 patients. Demographic data, including sex, age at the time of surgery, operated side, and implant material, were collected from the hospital database. Elbow range of motion (ROM), radiographic manifestation was recorded during the out-patient visit. The elbow joint function was evaluated according to the Broberg and Morrey elbow scale and Mayo elbow performance index score. Thirty patients, including 18 males and 12 females, were included in the CLS group, whereas 35 patients, including 21 males and 14 females, were included in the BS group. At 6-month follow-up, elbow range of motion, Broberg and Morrey elbow scale and Mayo elbow performance index scale showed no significant difference between the 2 groups. The carrying angle was within the normal range in both groups. There was no nonunion or malunion in either group. The rate of hypoplasia or hyperplasia was low in both groups, 3.3% in CLS and 2.9% in BS. The rate of implant prominence was significantly higher in the CLS group (33.3%) than BS (0%). Both CLS and BS are safe and effective choices for displaced MEFH in adolescents. The BS can produce a satisfactory clinical outcome and is comparable to the CLS. Besides, the BS has the advantage of not needing second surgery for implant removal.

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Section: Discussionmentioning

confidence: 99%

Is bioabsorbable screw an alternative choice for displaced medial epicondylar fractures in adolescents

Rai

et al. 2020

Medicine

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Section: Discussionunclassified

“…В действительности, несмотря на то, что золотым стандартом хирургического лечения ПМН является открытая репозиция с фиксацией канюлированными винтами [1], частота осложнений при этом методе достигает 31-41 % [19,24], что вызвано, главным образом, непереносимостью винтов. Кроме того, некоторые авторы сообщают о необходимости повторного хирургического вмешательства для извлечения винтов в 70 % случаев вследствие осложнений, связанных с фиксирующими аппаратами [24]. Так, согласно данным литературы, наиболее часто при использовании винтов встречаются клинически значимое выступление головки винта, сдавление и раздражение сухожилия трехглавой мышцы плеча при сгибании/разгибании предплечья вплоть до частичного поражения дистального мышечно-сухожильного соединения трехглавой мышцы плеча [19].…”

Section: Discussionunclassified

Open reduction and K-wires fixation of medial humeral epicondyle fractures with intra-articular elbow entrapment in children

Massetti

Marinelli

Coppa³

et al. 2020

Pediatr Traum Orthop Reconstr Surg

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Background. Medial epicondyle fracture (MEF) is a common injury of all elbow fractures in the pediatric and adolescent population and is often associated with elbow dislocation. Traditional management by cast immobilization increasingly is being replaced with early open reduction and K-wires or screws fixation. A consensus about the correct treatment of MEF is currently lacking in the medical literature. The aim of this study was to report the clinical and radiographic outcomes and the complications of patients affected from MEF with intra-articular fragment incarceration treated by open reduction and K-wire fixation. Materials and methods. Thirteen children (aged 813 years) with medial epicondyle fractures (MEF) with intra-articular elbow entrapment were retrospectively reviewed. All the enrolled patients were surgically treated with open reduction and k-wire fixation without exploration of ulnar nerve. Clinical outcomes were evaluated using upper limb alignment in the frontal plane, elbow range of motion (ROM), the Mayo Elbow Performance Score (MEPS) and with the Visual Analogue Scale (VAS). Radiographic outcomes and complications were also evaluated. Results. At a mean follow-up of 24.1 months no patients showed axial deformity of the upper limb or instability of the elbow and with preserved elbow ROM. The mean MEPS was 98.8 and the mean value of the VAS score was 1. The final X-rays showed fracture healing in 11 patients while 2 (15.3%) reported asymptomatic nonunion. Six patients of 13 presented with preoperative paresthesia in the ulnar nerve field but all of them reported a complete recovery after a mean of 4.3 months. All patients returned to their sporting activities at a mean of 5.4 months after surgery. One patient (7.7%) reported a superficial surgical wound infection treated with oral antibiotic medication without further surgery. No other complication was found. Conclusions. The results demonstrate that open reduction and K-wires fixation without exploration of ulnar nerve for MEF with intra-articular elbow entrapment treatment is a safe and effective procedure.

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“…We used k wires and didn't face problem as our group of patients were below 15 years unlike study by Pace et al where they used screws and washers in adolescent group. 10 A review article by Kapok et al titled as outcomes of non-operative treatment of medial epicondyle fractures in children with and without associated elbow dislocation opined that increased rates of non-union, stiffness and elbow laxity may be associated with nonsurgical treatment of fractures with dislocation and needed further validated studies. 11 Our study indirectly proves the point raised by this study.…”

Section: Discussionmentioning

confidence: 99%

Medial epicondyle fractures in children: a study of functional outcome of surgical fixation

2018

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Background: Medial epicondyle fracture is a common elbow injury in children. It is associated with elbow dislocation in many cases. Treatment of displaced medial epicondyle fracture with and without elbow dislocation is a debated topic. Surgical and non surgical methods are practiced with variable results.Methods: Our study was a prospective study of medial epicondyle fractures treated by surgical fixation with k wires. We studied total of 24 cases out of which 15 had elbow dislocation. The study period was from 2012 to 2015 and indications for surgery were displacement more than 5 mm, elbow instability, incarceration of fragment, ulnar nerve irritation. Open reduction and internal fixation with K wire done. We used joystick method while reducing the fragment with k wire which was a great help. We assessed the cases using mayo elbow performance score.Results: Our study yielded excellent results in 92% of patients (mayo elbow performance score >90). There was no major difference in clinical outcome between two groups of patients. Complications like instability and non-union not seen following surgical fixation with K wires. The mean loss of flexion, extension, supination, and pronation was 4, 5, 3 and 2 degrees respectively with elbow dislocation group and 2, 3, 1, 1 in without dislocation group. Pre op instability seen in 54% patients was absent in follow up period. Stiffness was more in elbow dislocation group but overall performance was almost equal.Conclusions: Surgical fixation of medial epicondyle fractures yields excellent results and may be advisable when indicated.

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Fixation of Displaced Medial Epicondyle Fractures in Adolescents

Abstract: Level IV.

Cited by 30 publications

References 20 publications

Is bioabsorbable screw an alternative choice for displaced medial epicondylar fractures in adolescents

Is bioabsorbable screw an alternative choice for displaced medial epicondylar fractures in adolescents

Open reduction and K-wires fixation of medial humeral epicondyle fractures with intra-articular elbow entrapment in children

Medial epicondyle fractures in children: a study of functional outcome of surgical fixation

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