Medial Humeral Epicondylar Fracture in Children and Adolescents

Abstract

Purpose. To assess treatment outcomes of young patients with medial epicondylar fracture of the elbow using standard operative protocols. Methods. 24 consecutive patients with medial humeral epicondylar fracture underwent surgery by one of the 3 methods: (1) 2 parallel Kirschner wires, (2) 2 parallel Kirschner wires plus a tension-band wire, and (3) a screw plus an anti-rotation Kirschner wire. Fractures displaced less than 5 mm were treated conservatively (casting for 3 weeks). Outcome was assessed clinically and radiologically. The Mayo Clinic Elbow Performance Index was measured. Results. The 3 patients with undisplaced fractures had good radiological results and scores. One patient with a displaced fracture refused surgery and subsequently developed pseudarthrosis and cubitus valgus. All operatively treated patients had good scores, but 2 treated with 2 parallel Kirschner wires alone developed pseudarthrosis. Surgery 2007;15(2):170-3 this group needed longer rehabilitation to attain a functional range of movement than those in other groups (treated together with a tension-band wire or screw). Conclusion. Surgery is recommended for children with displaced medial epicondylar fractures of more than 5 mm. The use of a tension-band wire, instead of a screw, together with Kirschner wires is the preferred treatment for younger children. Journal of Orthopaedic

Operative versus non-operative management of pediatric medial epicondyle fractures: A systematic review

“…Five studies had patients treated only with operative means [6, 7, 108, 109, 114]. Operative treatments included Kirschner wires [5–7, 10, 12, 108–110, 112–114], screw fixation [5, 7, 12, 109, 111, 112, 114], suture [5, 12, 109–111], excision of the fragment and suturing of the soft tissue to the periosteum of the medial elbow [10], tension band wiring [109, 112], Palmer pins [7, 110], closed reduction and percutaneous pinning [6], or open reduction alone [3]. In total, 321 patients received some type of operative treatment.…”

“…Two studies performed surgery when the medial epicondyle fracture was associated with dislocation of the humero-ulnar joint [113, 114]. Four studies performed surgery on significantly displaced fractures [11, 108, 112, 113], though significant displacement was variable in its definition. One used ulnar nerve symptoms as an indication for surgery [108].…”

The isolated medial humeral epicondyle fracture treated nonoperatively

“…Several studies have reported favourable outcomes with surgical treatment of displaced medial epicondyle fractures, particularly in avoiding radiological nonunion and valgus instability of the elbow [9][10][11][12][13]16,17]. However, several other studies have shown that nonoperative treatment can yield good long-term functional results, and that surgical intervention is not necessarily indicated even if fracture displacement is greater than 5 mm [3,5,7].…”

“…There has been hitherto no consensus on what constitutes 'significant' displacement. Displacements of greater than 2, 5 or 10 mm have been used as the threshold for surgical fixation in different studies; 5 mm seems to a frequently used cut-off [3,[7][8][9][10][11][12][13].…”

The Elbow and Forearm: Acquired Disorders

“…Another avulsion injury consists of purely muscular avulsion secondary to contraction of the forearm fl exors when the elbow is fl exed. This mechanism may be responsible for medial epicondylar fractures associated with arm wrestling and overhead throwing [ 22 ]. A displaced bony fragment can injure the ulnar nerve, which passes through a groove in the posterior aspect of the medial epicondyle.…”