What’s New in Pediatric Medial Epicondyle Fractures?

Beck, Jennifer J.; Bowen, Richard E.; Silva, Maurício

doi:10.1097/bpo.0000000000000902

Cited by 36 publications

(65 citation statements)

References 34 publications

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“…Yet, these established measurement ways were typically for the distal displacement cases, while for more complexed occasions in the proximal displaced, simple and reliable ways to measure were still in need, which is why this study resorted to more sophisticated ways like 3D-CT scans to get a precise measurement. In a recent review, Beck [18] and her colleagues acknowledged that besides the displacement measurement, the decision for surgery should be made on specific factors such as arm dominance and sport type the patients were to take.…”

Section: Discussionmentioning

confidence: 99%

“…Also, fracture displacement may improve over the conservative treatment period, a study result presented by Lim [23] and his colleagues, in which an average improvement of 1.55mm from 5.34mm at initial radiographs obtained. Yet high nonunion rates with up to 90% (17/19) in Farsetti [4] et al's and 50% (28/56) in Josefsson [18] et al's cohorts respectively occur in nonoperatively treated patients, though always asymptomatic. Yet, symptoms relating to nonunion like pain, elbow instability, and wrist flexion weakness do exist in some conservatively treated patients, especially in those adolescent athletes and the deciding factors and true incidence are still unknown, which explains the favor of some orthopedists for operative intervention.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

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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“…Medial epikondil kırıklarının tedavisi güncel literatürde halen tartışılmaktadır (3,(5)(6)(7)(8). Açık kırıklar ve medial epikondilin dirsek eklem içine inkarserasyonu cerrahi için kesin endikasyonlar olarak bildirilmiştir (1,2).…”

Section: Introductionunclassified

“…Açık kırıklar ve medial epikondilin dirsek eklem içine inkarserasyonu cerrahi için kesin endikasyonlar olarak bildirilmiştir (1,2). Bununla birlikte dirsekte valgus instabiltesi ve ulnar sinir disfonksiyonu ise rölatif cerrahi endikasyonlardır (1,2,6). Kırık deplasman miktarı çeşitli çalışmalarda farklı olarak bildirilse de, cerrahi endikasyon koymada halen önem taşımaktadır.…”

Section: Introductionunclassified

Mid-term Clinical and Radiological Results of Surgically Treated Pediatric Medial Humeral Epicondyle Fractures: Screw or K Wire?

Onay¹,

Okay²

2018

BTDMJB

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Objective: The aim of the present study was to evaluate the clinical and radiological results of surgically treated pediatric medial humeral epicondyle fractures which were fixed with screw or K wire. Materials and Methods: The study was designed retrospectively. Twenty two patients were evaluated clinically and radiologically. Functional outcomes were assessed with the Mayo elbow performance index (MEPI) and the Turkish language version of the shortened version of the Disabilities of Arm, Shoulder, and Hand (Quick DASH) scale. Results: All fractures were healed. The mean MEPI was 99.3 points (range, 85-100), with 21 patients as excellent and 1 good results. The mean MEPI was 100 points for patient who was fixed with K wires (group A). Excellent results were obtained for all patients. The mean MEPI was 97.9 points (range, 85-100) for patients with screw fixation (group B). Excellent results were obtained for all patients, except one. The mean Quick DASH score was 0.63 (range, 0-9). It was found 0.33 (range 0-5) and 1.3 (range, 0-9) for group A and group B, respectively. Two (13%) minor complications were developed in group A and 4 (57.3%) in group B. The difference for Quick DASH and MEPI scores were statistically insignificant (p>0.05). Conclusion: Both of fixations with K wire or screw provide enough stability until the fracture healed. Fracture union could be obtained for both fixation type and the clinical and radiological results were similar. The need for secondary operation for implant removal and higher complication rates seems the negative side of screw fixation.

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“…В литературе описано несколько систем классификации, большинство из которых основано на степени смещения МН. В широко используемой классификации выделяют острые, хронические ПМН и острые переломы при сопутствующей хронической патологии [3]. В настоящее время, согласно данным медицинской литературы, единого мнения в отношении правильного метода лечения ПМН не существует, нет также четких показаний относительно величины смещения.…”

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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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What’s New in Pediatric Medial Epicondyle Fractures?

Abstract: Level 5.

Cited by 36 publications

References 34 publications

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

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

Mid-term Clinical and Radiological Results of Surgically Treated Pediatric Medial Humeral Epicondyle Fractures: Screw or K Wire?

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

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