Operative Fixation of Medial Humeral Epicondyle Fracture Nonunion in Children
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.
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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
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ABSTRACT: The present review discusses the relevant anatomy, clinical presentation, and management of medial epicondyle fractures, including diagnostic controversies, the indications for operative and nonoperative management, and outcomes. Recent studies have highlighted the underestimation of fracture displacement seen on typical radiographic views and have attempted to define the location of the medial epicondyle on radiographs to improve the accuracy of measuring displacement. They have demonstrated variable outcomes following open reduction and internal fixation of medial epicondyle fractures that are associated with intra-articular incarceration. Newer evidence supports the fixation of medial epicondyle fractures in adolescent athletes, to allow return to competitive sports. Medial epicondyle fractures of the distal humerus account for 12% of pediatric elbow fractures and are frequently associated with intra-articular incarceration of the fracture fragment, elbow dislocation, ulnar nerve injury, and other upper extremity fractures. Recent literature calls into question the accuracy of measuring fracture displacement, and controversy exists regarding optimal management of these fractures. Good outcomes have been achieved with nonoperative treatment for minimally displaced fractures, despite a high rate of nonunion. In patients with displaced fractures, fixation yields stability, functional range of motion, and the ability to return to previous activity levels, including sports. Complications include stiffness, instability, deformity, superficial wound infections, and symptomatic nonunion. Further study is required to standardize the measurement of displacement and to clarify indications for operative treatment in both sedentary and active children.Current Opinion in Pediatrics 02/2015; 27(1):58-66. DOI:10.1097/MOP.0000000000000181 · 2.74 Impact Factor
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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