Open Reduction Internal Fixation of a Medial Epicondyle Avulsion Fracture With Incarcerated Fragment

Ostrander, James; O’Connell, Megan E; Dolch, Henry J

doi:10.1097/bot.0000000000001530

Cited by 5 publications

(3 citation statements)

References 7 publications

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“…[ 2 ] However, open reduction and internal fixation (ORIF) is gaining favors among orthopedic surgeons due to the functional demands of adolescent patients and evolving knowledge of the role of medial epicondyle. [ 3 , 4 ] Besides, ORIF offers a significantly higher union rate than nonsurgical methods. [ 5 – 7 ] Therefore, ORIF was adopted at our institute for significantly displaced or incarcerated MEFH.…”

Section: Introductionmentioning

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: Introductionmentioning

confidence: 99%

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

Rai

et al. 2020

Medicine

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“…[2][3][4][5] Controversy surrounds the decision of whether or not to operate, with historic accounts of good outcomes from nonoperative treatment even in the setting of significant displacement and fibrous nonunion. [6][7][8][9][10] While absolute indications for surgical management (ie, open fracture, ulnar nerve dysfunction and intraarticular fragment entrapment) are straightforward, 11,12 relative indications (eg, valgus instability, limb dominance, participation in gymnastics or baseball pitching, and amount of fragment displacement) are less clear.…”

mentioning

confidence: 99%

“…While absolute indications for surgical management (ie, open fracture, ulnar nerve dysfunction and intraarticular fragment entrapment) are straightforward,11,12 relative indications (eg, valgus instability, limb dominance, participation in gymnastics or baseball pitching, and amount of fragment displacement) are less clear. There is no universally accepted guideline of how much displacement warrants surgical fixation, with reported thresholds for surgery ranging from 2 to 20 mm 6,8,13–20…”

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confidence: 99%

Use of Digital Tomosynthesis in Assessing Accurate Medial Epicondyle Fracture Displacement as Compared With Conventional Radiography and Computed Tomography

Livingston

Edwards

Griffin

et al. 2021

Journal of Pediatric Orthopaedics

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Introduction: Medial epicondyle fracture displacement is notoriously difficult to determine on conventional radiography, and follow-up computed tomography (CT) is often obtained to measure precise displacement. Another option for fracture characterization is digital tomosynthesis (DT), a technology providing high in-plane resolution of bony anatomy by acquiring multiple low-dose images in a linear arc. Advantages of DT include lower radiation exposure and lower cost than CT, rapid image acquisition, and a similar patient experience to conventional radiography. The digital application of tomosynthesis is relatively new and is integrated as an add-on feature with modern radiography equipment. This study compares DT, CT and conventional radiography for measurement accuracy in medial epicondyle fractures with the goal of determining relative accuracy in measuring medial epicondyle fracture displacement. Methods: Medial epicondyle fractures were created in 5 cadaveric elbow specimens. Each specimen was imaged with conventional radiography, DT, and CT. True displacement measured by digital calipers was compared with “measured” displacement for each image acquisition. CT images included axial, sagittal, and coronal reformats. DT images of the elbow included anteroposterior (AP) longitudinal and transverse, lateral longitudinal and transverse, and axial longitudinal and transverse. Conventional radiographs included AP, lateral, and axial distal humerus images. Four physicians reviewed all images 3 months later. Each reviewer independently measured maximum apparent fracture displacement to the nearest 0.1 mm. Measurement accuracy was calculated as percent difference [(measured displacement−actual displacement)/actual displacement] for each acquisition. Mean, median, and SD for measurement accuracy were calculated. Two-tailed paired t tests were performed on each acquisition to compare the measurement accuracy. Results: Compared with conventional radiographs, accuracy of DT was superior in AP longitudinal ( P =0.03), AP transverse ( P =0.01), axial longitudinal ( P =0.0001), and axial transverse projections ( P =0.001). Accuracy of CT was superior to conventional radiography in the AP projection ( P =0.03), but was equivalent in the axial projection ( P =0.9). Accuracy of CT was similar to DT in AP longitudinal ( P =0.6), AP transverse ( P =0.5), and axial longitudinal projections ( P =0.07). Accuracy of DT in the axial transverse projection was superior to CT ( P =0.03). Conclusion: DT is more accurate than conventional radiography (both AP and axial views) and as accurate as CT in assessing millimeters of displacement of medial epic...

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Medial Elbow Disorders

Pettyjohn

Zaremski

2022

Clinical Guide to Musculoskeletal Medicine

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Open Reduction Internal Fixation of a Medial Epicondyle Avulsion Fracture With Incarcerated Fragment

Cited by 5 publications

References 7 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

Use of Digital Tomosynthesis in Assessing Accurate Medial Epicondyle Fracture Displacement as Compared With Conventional Radiography and Computed Tomography

Medial Elbow Disorders

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