Open reduction of medial epicondyle fractures: Operative tips for technical ease

Abstract

In the pediatric population, medial humeral epicondylar fractures account for nearly 12% of all elbow fractures. There is ongoing debate about the surgical management of medial epicondyle fracture cases. Our technique in the operative management of medial epicondyle fractures uses the external application of an Esmarch bandage, as well as provisional fixation with needle rather than K-wire fixation. This technique decreases the need for soft-tissue release and, therefore, theoretically, maintains soft-tissue vascularity of the small fracture fragments. Moreover, it preserves the soft-tissue tension medially. It involves the use of a bandage that is universally available in orthopedic operating rooms, including those in developing nations. It is easy to apply by either the principal or assisting surgeon. With practice, it cuts down operative time and can help substitute for an assistant. This relatively simple operative technique makes for a more seamless operative process, improved reduction, and key preservation of soft-tissue vascularity.

Pediatric medial epicondyle fractures with intra-articular elbow incarceration

“…Many authors agree that fractures of the medial epicondyle with incarceration of the fragment in the elbow joint (type III) should be surgically treated [ 12 , 17 – 20 ]. Multiple methods of surgical treatment have been reported: fragment excision and sutures [ 10 , 21 ], closed reduction and percutaneous Kirshner wires [ 22 ], open reduction and Kirshner wires [ 10 , 23 – 25 ], open reduction and sutures [ 6 , 9 , 26 ], open reduction and smooth pins [ 9 , 27 ], and open reduction and screws [ 11 , 25 , 28 ]. The goals of operative fixation are to maximize the possibility of early return to full function and high-level activity and to minimize late deformity and the likelihood of stiffness (as with prolonged cast immobilization).…”

“…In fact, it has been suggested that the ratio of elbow growth to width has the same biomechanical importance as longitudinal growth in terms of muscle balance and stability [ 32 ]. Therefore, in very young patients, K-wire fixation should be preferred, since screws should be routinely removed to avoid growth anomalies [ 28 , 33 ].…”

Extraction of incarcerated medial epicondyle from the elbow joint using conventional nerve stimulator: a case report

“…This novel technique however facilitates a minimally invasive approach, reducing the amount of force applied, preventing complications such as soft tissue injury, fragment splitting and periosteal stripping caused by surgical instruments [ 5 ]. Furthermore this is the first known report of its kind and as such may have valid application for a wide range of avulsion fractures.…”

“…This simple technique using a commonly available nerve stimulator may obviate the need for extensile open reduction [ 5 ] for extraction of an incarcerated ME. We would recommend this technique where other closed reduction methods have failed.…”

Common Paediatric Elbow Injuries

“…Medial epicondyle fractures, also known as “Little Leaguer’s elbow” due to an association with throwing athletes, most commonly affects children aged 8-14 years, but beware the younger child with a minimally ossified epicondyle. They represent approximately 12% of paediatric elbow injuries [ 49 , 50 ]. The fracture occurs as a result of traction from the medial collateral ligament and flexor mass avulsing the medial epicondylar apophysis.…”