Functional Loss With Displacement of Medial Epicondyle Humerus Fractures

Edmonds, Eric W.; Santago, Anthony C.; Saul, Katherine R.

doi:10.1097/bpo.0000000000000371

Cited by 20 publications

(10 citation statements)

References 29 publications

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“…The obtained questionnaire history included age at time of injury, current age, hand dominance, treatment method, length of immobilization, need for formal physical therapy, pre- and postinjury athletic level (specifically inquiring about participation in overhead sports), subsequent treatment including further surgeries, current symptoms, and treatment satisfaction. Prospective objective data collection included radiographs (standard anteroposterior and lateral radiographs, as well as the axial distal humerus view) [ 11 ], physical examination, and grip strength testing with a Jamar dynamometer. Physical examination motion and alignment measurements were all recorded using a goniometer.…”

Section: Methodsmentioning

confidence: 99%

Does operative fixation affect outcomes of displaced medial epicondyle fractures?

Stepanovich

Bastrom

Munch

et al. 2016

Journal of Children's Orthopaedics

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PurposeLong-term functional results remain equivocal between operative fixation and closed management of displaced humeral medial epicondyle fractures. The purpose of this study was to determine whether a functional difference exists between treatment types.MethodsOne hundred and forty patients with a displaced medial epicondyle fracture between 2007 and 2014 met the inclusion criteria. Of this large cohort, only 12 patients agreed to return to clinic at a mean follow-up of 3 years for prospective evaluation. Data collection included radiographs, physical examination, validated outcome tools, and grip strength testing with a Jamar dynamometer.ResultsBoth groups were comparable with regard to age, dominant side injured, length of follow-up, preinjury sports involvement, and initial displacement (10 mm operative vs. 9 mm nonoperative); however, half of the surgical group presented with an associated unreduced elbow dislocation versus 0 % in the nonoperative group. Both treatment methods resulted in high patient satisfaction and elbow function scores. There were four osseous nonunions (67 %) and one malunion (17 %) in the nonoperative group versus none in the operative group (p = 0.015). Patients treated nonoperatively had a nonsignificant decrease in grip strength (9 ± 6 lbs) as compared to operative patients (6 ± 5 lbs, medium effect size eta = 0.25, p = 0.25).ConclusionsIn this small cohort, operative management of displaced medial epicondyle fractures resulted in a higher rate of fracture union and return to sports. Other objective and subjective measures were similar between the two treatment groups.

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Section: Methodsmentioning

confidence: 99%

Does operative fixation affect outcomes of displaced medial epicondyle fractures?

Stepanovich

Bastrom

Munch

et al. 2016

Journal of Children's Orthopaedics

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“…Irrespective of a relatively low rate of bony union, the nonsurgical treatment provides good to excellent functional results. [ 19 – 22 ] However, the nonsurgical treatment with cast application and immobilization of fractured elbow is increasingly being replaced by surgical fixation. [ 16 , 19 ] The primary purpose of surgical fixation is to achieve an anatomic reduction and early mobilization.…”

Section: Discussionmentioning

confidence: 99%

“…[ 19 – 22 ] However, the nonsurgical treatment with cast application and immobilization of fractured elbow is increasingly being replaced by surgical fixation. [ 16 , 19 ] The primary purpose of surgical fixation is to achieve an anatomic reduction and early mobilization. Kamath et al found a significantly higher union rate in operative fixation (92.5%) than nonoperative management (49.2%).…”

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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“…Traditional treatment algorism for moderate displaced ones suggests cast immobilization when the displacement is less than 5mm, and operation when the displacement is more than 5mm [1,5]. A research by Edmonds [16] et al did show the relationship between displacement amount and outcomes like wrist flexion strength (approximate 2% decrease for every 1mm of anterior displacement due to muscle shortening). Yet the deemed displacement was usually measured on AP or lateral plain X-rays, which was with great deviation and did not represent the true displacement of the fracture, making it hard to justify the treatment strategy [17].…”

Section: Discussionmentioning

confidence: 99%

Proximally displaced medial humeral epicondyle fracture in pediatric patients: A clinical case series

et al. 2020

Preprint

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Background Medial epicondyle fracture comprises a considerable proportion of pediatric elbow injury. The fracture fragment is typically pulled distally by the muscle and the ligament. This study aims to suggest proper recognition of a subset of the fracture that differs from its usual presentation. Methods A retrospective case study was conducted during 2011–2016. Of those cases, a subset was identified as proximally displaced (atypical) ones. Distinctive radiologic images, as well as the injury causes, demographic data, clinical signs, treatment ways, and final follow-ups regarding these atypical ones, were presented and discussed. The fracture mechanism was carefully inferred from former theories and the operative findings, and a tentative management strategy was suggested. Results Seven out of 112 cases were distinguished as the atypical, which represents 6.25% of the whole sample. Injury causes were all direct or combined direct/indirect force injuries instead of indirect force mostly seen in the typical. Five were operated while two nonoperatively treated. Operated cases revealed stripping of medial epicondyle from its surrounding periosteum/muscle origin or even cartilage. The fracture fragment was either pulled by proximal periosteum or even proximally dissociated. The outcomes of those atypical were mostly acceptable despite some minor defects. Conclusion The proximally displaced cases do constitute a portion of medial humeral epicondyle fracture in children. As well as its skeletal manifestation, awareness of its injury mechanism and soft tissue damage is required. Precise restoration of its anatomical structure might be vital for its treatment. Further scientific work is needed regarding its mechanism and management. Level of evidence: Level 4.

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Functional Loss With Displacement of Medial Epicondyle Humerus Fractures

Cited by 20 publications

References 29 publications

Does operative fixation affect outcomes of displaced medial epicondyle fractures?

Does operative fixation affect outcomes of displaced medial epicondyle fractures?

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

Proximally displaced medial humeral epicondyle fracture in pediatric patients: A clinical case series

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