Article

Operative Fixation of Medial Humeral Epicondyle Fracture Nonunion in Children

Department of Orthopaedics, Children's Hospital Boston, Boston, MA 02115, USA.
Journal of pediatric orthopedics (Impact Factor: 1.43). 10/2010; 30(7):644-8. DOI: 10.1097/BPO.0b013e3181ed4381
Source: PubMed

ABSTRACT There is little information regarding the clinical presentation and/or surgical treatment of symptomatic medial humeral epicondyle nonunions. The purpose of this investigation was to describe the presenting symptoms and evaluate the results of surgical fixation of medial epicondyle nonunions.
Eight patients with symptomatic medial humeral epicondyle nonunions were evaluated after open reduction and internal fixation of the medial epicondyle. Average age at the time of initial injury was 11.3 years (range: 9.2 to 13.9 y). Outcome was assessed with radiographs and a questionnaire that included 3 self-reported functional outcome tools at a mean of 4.7 years (range: 1.5 to 7.5 y) after the surgery.
Common presenting symptoms and signs included medial elbow pain and prominence, pain with lifting weights or throwing, limited range of motion, valgus instability, and ulnar nerve compression. After open reduction and internal fixation, patients reported improved pain score from a mean of 6.2 to 0.5. All patients returned to athletics. Mean postoperative QuickDASH (Disability of Arm, Shoulder, and Hand) score (and SD) was 6.8 ± 11.7; mean Mayo Elbow Performance Score was 85.8 ± 14.6; and mean Timmerman-Andrews Elbow Score was 87.5 ± 10.4. Radiographic union was achieved in all but one patient postoperatively and there were no operative complications.
Open reduction and internal fixation of symptomatic medial humeral epicondyle nonunion results in improved pain and good elbow function.
Retrospective Case Series. Therapeutic Level IV.

0 Followers
 · 
101 Views
 · 
0 Downloads
  • Source
    • "The diagnosis and evaluation of the displacement in medial humeral epicondyle fracture is difficult, because the epicondyle is small, the displacement is overlapped by the distal humeral metaphysis or it is often confused with the other trochlear ossification center.4,12 Delayed diagnosis and stiffness due to the displaced intraarticular fragment have been reported.5,12 However, except for the displaced intraarticular fragments, good long-term results of nonsurgical treatment of medial humeral epicondyle fracture have usually been obtained even in the cases with nonunion.7 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose Displaced medial humeral epicondyle fractures with or without elbow dislocation have been treated with open reduction and fixation using K-wires or screws. The purpose of this study is to evaluate the clinical and radiological outcomes of surgical treatments of medial humeral epicondyle fracture without elbow dislocation according to the fixation methods. Materials and Methods Thirty-one patients who had undergone open reduction and fixation of the displaced medial humeral epicondyle fracture without elbow dislocation were included. Group I consisted of 21 patients who underwent fixation with K-wires, and Group II comprised 10 patients who underwent fixation with cannulated screws. Immediate postoperative, final follow-up and normal anteroposterior radiographs were compared and the clinical outcome was assessed using the final Japanese Orthopaedic Association (JOA) elbow assessment score. Results On the immediate postoperative radiographs, the distal humeral width in Group II was larger than that in Group I. On the final follow-up radiographs, the epicondylar position in Group I was lower than that in Group II. There was no significant difference in the distal humeral width, epicondylar position and joint space tilt between the immediate postoperative, final follow-up radiographs and the normal side within each group. There was no significant difference in the final JOA score between groups. Conclusion Open reduction followed by K-wire fixation or screw fixation of the displaced medial humeral epicondyle fracture without elbow dislocation in older children and adolescents resulted in improved radiologic outcome and good elbow function in spite of diverse radiologic deformities.
    Yonsei medical journal 11/2012; 53(6):1190-6. DOI:10.3349/ymj.2012.53.6.1190 · 1.26 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Symptomatic nonunion of humeral medial epicondyle can be problematic and difficult to treat due to high complication rates related to open reduction and internal fixation methods. We described four patients with symptomatic medial humeral epicondyle nonunion who underwent open reduction and internal fixation. Symptomatic nonunion of humeral medial epicondyle is a rare entity. Surgical technique can be difficult because of anatomical and biomechanical factors. In the literature, there are a few cases of humeral medial epicondyle treated by open reduction and internal fixation. Open reduction and internally fixation of the medial epicondyle nonunion with one cannulated screw results with improved elbow function.
    05/2012; 3(9):467-70. DOI:10.1016/j.ijscr.2012.04.021
  • [Show abstract] [Hide abstract]
    ABSTRACT: Displaced medial epicondyle fractures are common injuries encountered in pediatric orthopaedic practice. Many practitioners have successful personal experience treating these fractures through nonoperative and operative techniques. This article discusses evidence-based medicine principles related to medial epicondyle fractures. There is a dearth of high-level evidence, and yet we are constantly faced with the need for clinical decision making in the face of uncertainty. Although highly susceptible to bias, pertinent background information (current pediatric fracture textbooks) and meta-analysis of clinical research with a particular focus on harm (and number needed to harm) support surgical recommendations for most patients.
    Journal of pediatric orthopedics 09/2012; 32 Suppl 2:S135-42. DOI:10.1097/BPO.0b013e31824bdb78 · 1.43 Impact Factor
Show more