Surgery for medial epicondyle fractures yielded excellent function, minimal pain in pediatric patients
Click Here to Manage Email Alerts
Operative treatment of medial epicondyle fractures may lead to excellent upper extremity function and minimal pain interference among most pediatric patients, according to results.
Using the patient-reported outcomes measurement information system (PROMIS) upper extremity and pain interference domains, VAS for pain, range of motion, ulnar nerve function and requirement for secondary surgery, Ronak Mukesh Patel, MD, and colleagues assessed the outcomes of 42 patients younger than 18 years of age who were treated surgically for medial epicondyle fracture between 2005 and 2016.
Although 19% of patients noticed mild sensory or motor issues related to the ulnar nerve and 7% of patients reported dissatisfaction with elbow range of motion, Patel told Healio Orthopedics that all patients reported excellent function and pain scores at final follow-up. Results showed patients had a mean PROMIS upper extremity score of 57, a mean PROMIS pain interference score of 38.3 and a mean VAS score of 0.3.
“The reoperation rate was high (45%), primarily related to removal of painful hardware,” Patel said. “We did not have any patients who required reoperation for symptomatic nonunion, which was a surprising finding.”
Researchers found worse PROMIS pain interference scores among patients who required secondary surgeries, but no differences in PROMIS upper extremity scores.
“Our results can help counsel patients and families of the aforementioned findings, as well as on the high rates of reoperation,” Patel said. – by Casey Tingle
Reference:
Patel RM, et al. ePaper 282. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2020 (meeting canceled).
Disclosure: Patel reports no relevant financial disclosures.
Perspective
Back to Top
Jonathan D. Barlow, MD
Medial epicondyle fractures remain a controversial area of treatment. While pediatric orthopedic surgeons have traditionally preferred nonsurgical management, the long-term impact of nonsurgical management remains somewhat unclear. Furthermore, when patients present as adolescents or young adults with old, untreated injuries, reconstruction can be challenging. In the growing era of “Tommy John” surgery and other medial elbow surgical procedures in athletes, there has been increased scrutiny on the need for surgery in young patients with displaced medial epicondyle fractures. This article nicely demonstrates a low rate of long-term or severe complications. The hardware removal rate (41%) is not unexpected given the subcutaneous nature of the medial epicondyle, particularly in young patients. While this article does not compare their outcomes with non-surgically managed patients, the outcomes would indicate that fixation of these fractures is safe and effective with minimal long-term complications.
Assistant professor of orthopedics
Rochester, Minnesota
Read more about
Click Here to Manage Email Alerts