Editor’s note: The following content was published in the AAOS Now Special Edition and distributed in June 2020. The content was originally scheduled for the AAOS Now Daily Edition, which publishes each year onsite at the AAOS Annual Meeting but this year’s meeting in March was canceled due to COVID-19. Despite the cancellation, members can access virtual content from the Annual Meeting by visiting the Academy’s Annual Meeting Virtual Experience webpage.

After more than six years of follow-up, researchers observed that operative treatment of medial epicondyle fracture in pediatric patients resulted in “excellent” clinical outcomes. Ronak M. Patel, MD, a chief resident in the Department of Orthopaedics at Washington University in St. Louis, presented the study’s findings as part of the Annual Meeting Virtual Experience.

“Charles A. Goldfarb, MD, and I undertook this study to delve into the controversy of treatment of medial epicondyle fractures, specifically surgical versus nonsurgical care,” Dr. Patel told AAOS Now. 

“Given the lack of clear data, we were concerned about the increasing rates of surgery for this injury. Our experience has resulted in favorable surgical outcomes, but we have noted a small subset of patients with complications such as loss of motion, symptomatic hardware, and nonunion,” he added.

Researchers retrospectively reviewed data on 42 patients aged younger than 18 years who were surgically treated for medial epicondyle fractures at a single institution by one of 12 surgeons between 2005 and 2016. The most common associated injury was elbow dislocation (n = 27; 64 percent). Mean age at surgery was 12.0 years (range, 7.3–16.0 years), and mean time from injury to surgery was 6.7 days (range, 0–94 days).

Researchers assessed Patient-reported Outcomes Measurement Information System (PROMIS) domains for upper extremity (UE) and pain interference (PI), as well as visual analog scale score for pain, range of motion (ROM), ulnar nerve function, and requirement for secondary surgery.

Patients were followed for an average of 6.2 years (range, 2.2–13.9 years). Mean age at follow-up was 18.2 years (range, 9.5–23.5 years).

Outcome measures and pain scores after surgery were “excellent,” according to the authors (Table 1).

Nearly half of patients (45 percent; n = 19) required secondary surgeries, most of which were for removal of symptomatic hardware. Dr. Patel said the team was surprised that no patients required reoperation for symptomatic nonunion.

Eight patients (19 percent) reported sensory complaints, and two (5 percent) reported motor complaints consistent with ulnar nerve irritability. Three patients (7 percent) were dissatisfied with elbow ROM. Patients who required secondary surgeries had worse PROMIS PI scores than those who did not (mean difference, 2.7; 95 percent confidence interval, 0.3–5.1; P = 0.0306). PROMIS UE scores did not differ between those who did and did not undergo secondary surgeries.

“Operative treatment of medial epicondyle fractures results in successful outcomes for the vast majority of patients; however, patients and families should be counseled on the high rates of reoperation,” Dr. Patel concluded.

The study is limited by its retrospective design and lack of radiographic outcomes.

Dr. Patel’s coauthors of Paper 282, “Long-Term Outcomes of Operatively Treated Medial Epicondyle Fractures in Pediatric Patients,” are Yash R. Tarkunde, BS; Gregory Schimizzi, MD, PhD; and Charles A. Goldfarb, MD.

Kerri Fitzgerald is the managing editor of AAOS Now. She can be reached at kefitzgerald@aaos.org.