Comparison of outcome between nonoperative and operative treatment of medial epicondyle fractures

Abstract

Background and purpose — Controversy exists regarding
the optimal treatment for displaced medial epicondyle
fractures. We compared the results of nonoperative and
operative treatment and calculated the incidence of medial
epicondyle fractures in the pediatric census population.

Patients and methods — 112 children under 16 years
old who sustained > 2 mm displaced fracture of the medial
epicondyle were treated in our institution between 2014 and
2019. 80/83 patients with 81 non-incarcerated fractures were
available for minimum 1-year follow-up. 41 fractures were
treated with immobilization only, 40 by open reduction and
internal fixation, according to the preference of the attending
surgeon. Outcome was assessed at mean 2.6 years (1–6)
from injury with different patient-reported outcome measures.
Elbow stability, range of motion, grip strength, and
distal sensation were registered in 74/80 patients. Incidence
was calculated for 7- to 15-year-olds.

Results — Nonoperatively treated children had less pain
according to the PedsQL Pediatric Pain Questionnaire (3
vs. 15, p = 0.01) with better cosmetic outcome (VAS 95 vs.
87, p = 0.007). There was no statistically significant difference
between the groups in respect of QuickDASH, PedsQL
generic core scale, Mayo Elbow Performance Score, grip
strength, carrying angle, elbow stability, or range of motion
(p > 0.05). All 41 nonoperatively treated children returned to
pre-injury sports; of the surgically treated 6/40 had to downscale
their sporting activities. The incidence of displaced (>
2 mm) fractures of the medial epicondyle in children aged
7–15 years was ≥ 3:100,000.

Interpretation — Displaced fractures of the medial
humeral epicondyle in children heal well with 3–4 weeks’
immobilization. Open reduction and screw fixation does not
improve outcome.