Die Behandlung der Apophysenabrissverletzung des Epicondylus ulnaris im Kindesalter

Abstract

From January 1, 1994 to December 31, 2003, 25 children with an average age of 12 years suffering from medial epicondylar avulsion fractures were operated on using open reduction and Kirschner wire fixation. An average of 3 years after the injury 14 of these children underwent follow-up examination using a procedure that took subjective, clinical and radiologic parameters into account. Two children showed a slight reduction in overall strength of the injured extremity when compared with the contralateral extremity. One child had a flexion deficit of 10 degrees, all other children showed movement limitations of < or = 5 degrees compared to the contralateral extremity. In all the cases available to follow-up, there was a slight increase in valgus alignment of the elbow joint compared with the uninjured side (3 degrees on average). All fractures consolidated within 6 weeks.

Open reduction of medial epicondyle fractures: Operative tips for technical ease

“…To these authors, temporary apophysiodesis with screw in the preadolescent group is also relatively contraindicated; they recommend screw fixation only for adolescents [22,24]. We agree with this concept that K-wire fixation should be used in the very young.…”

“…Reducing a fracture with K-wire fixation only stabilizes the injury without compressing fracture fragments. Although the screw may cause uncomfortable prominence and the need for subsequent hardware removal [24], we believe that this should not deter the orthopedist from performing an open reduction to achieve complete union of medial epicondylar fractures, and this view has been supported by other experts [25]. Furthermore, the risk of symptomatic non-union is clearly evident when using either non-operative management or simple K-wire fixation that does not employ compression principles [15].…”

Operative versus non-operative management of pediatric medial epicondyle fractures: A systematic review

“…Seven papers were excluded because they did not fulfill the pediatric population criteria [2, 98–103]. Five articles were primary radiographic articles with no focus on the treatment of medial epicondyle fractures [104–108]. …”

Acute, avulsion fractures of the medial epicondyle while throwing in youth baseball players: A variant of Little League elbow

“…[8][9][10]18 For more displaced fractures, numerous series have shown equally good outcomes among patients treated conservatively with a long arm cast and open reduction and internal fixation. 3,5,[8][9][10]15,17,18,20 Analogous to rupture of the ulnar collateral ligament in baseball pitchers, more extreme valgus instability associated with the pitching motion secondary to malunion or nonunion in youth baseball players may limit performance but not interfere with elbow function performed during activities of daily living. 16,27 Gilchrist et al 11 reported a case series of 5 patients who had suboptimal outcomes, with late valgus instability and inability to participate in throwing activities after nonoperative management of medial epicondyle fractures.…”

“…Much debate within the literature exists about optimal treatment of medial epicondylar fractures. 3,5,[8][9][10]15,17,18,20,26 Most authors agree that nondisplaced or minimally displaced fractures, defined as 0 to 5 mm of displacement, are best treated with a brief period of immobilization. [8][9][10]18 For more displaced fractures, numerous series have shown equally good outcomes among patients treated conservatively with a long arm cast and open reduction and internal fixation.…”