Medial Epicondyle Nonunions in Children: Case Report With Overview and Management

Chorney, Matthew; Sylvestre, Daniel; Seeley, Mark

doi:10.5435/jaaosglobal-d-18-00046

Cited by 6 publications

(6 citation statements)

References 17 publications

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“…Nevertheless, it is worth of note that some authors have reported pain, functional impairment, and valgus instability associated with fibrous union and non-union, particularly during sport. [21][22][23] The compressive torque guaranteed by the screws could, at least in part, explain the lower rate of fibrous union reported in Group B. In addition, the osteoconductive properties demonstrated by the Mg alloy may play a role.…”

Section: Discussionmentioning

confidence: 99%

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Resorbable magnesium screws for fixation of medial epicondyle avulsion fractures in skeletally immature patients: A comparison with Kirschner wires

Baldini

Coppa

Falcioni

et al. 2022

Journal of Children's Orthopaedics

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Background: Displaced medial epicondyle fractures are treated with open reduction and internal fixation with K-wires or screws. Rates of implant prominence, failure, or non-union reported are considerable. Magnesium screws have demonstrated biocompatibility, osteoconductivity, and high pull-out strength. The aim of this study was to compare surgical fixation of medial epicondyle fracture using resorbable magnesium Herbert screws to K-wires, in skeletally immature patients. Methods: A retrospective analysis was performed from January 2015 to April 2020. Inclusion criteria were as follows displaced medial epicondyle fracture, <15 years, and absence of concomitant ipsilateral upper limb fractures. Two consecutive cohorts based on fixation device were made: Group A (wires) and Group B (magnesium screws). Alignment, pain, range of motion, Mayo Elbow Performance Score, and radiological healing were assessed. Results: A total of 27 patients were included: 15 in Group A and 12 in Group B. Groups were comparable for age and sex. Mean follow-up was higher in Group A (38.73 ± 3.15 vs 26.18 ± 4.85 months; p < 0.001). No significant differences were observed regarding range of motion, alignment, pain, and Mayo Elbow Performance Score, with excellent results in both groups. Two patients in Group A developed a deep wound pin site infection requiring antibiotics. X-rays revealed three cases of non-union in Group A and one in Group B, all of them asymptomatic. No patient required a second surgical procedure. Conclusion: Open reduction and internal fixation of medial epicondyle fractures with magnesium screws showed comparable results to a widely accepted procedure such as the use of K-wires, potentially with a lower incidence of non-union and infection. No adverse reactions were recorded. Level of evidence: level III.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Resorbable magnesium screws for fixation of medial epicondyle avulsion fractures in skeletally immature patients: A comparison with Kirschner wires

Baldini

Coppa

Falcioni

et al. 2022

Journal of Children's Orthopaedics

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“…Although symptomatic nonunion of the medial humeral epicondyle is a relatively rare entity, it is known as a challenging complication [ 23 , 24 ]. Few studies have shown that even medial epicondyle fractures with >5 mm of displacement can be managed nonoperatively [ 5 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Is Computed Tomography Necessary for Diagnostic Workup in Displaced Pediatric Medial Epicondyle Fractures?

Kim

Park

et al. 2020

Diagnostics

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This study aimed to compare the treatment outcomes and complications between operatively and nonoperatively treated medial epicondyle fractures with displacement of >5 mm as accurately measured on three-dimensional computed tomography (3D CT). We retrospectively reviewed 77 patients who had isolated medial epicondylar fractures with displacement of >5 mm. The mean age at injury was 11.4 years. Patients were assigned to one of two groups: 21 patients treated nonoperatively and 56 patients treated surgically. Additionally, patients treated operatively were divided into two subgroups according to fixation method; 31 patients underwent internal fixation with K-wires and 25 patients underwent internal fixation with a screw. Radiological and functional outcomes were compared among the three groups. Although the bony union rate was significantly higher in patients treated operatively compared to patients treated non-operatively (96.4% vs. 23.8%, p < 0.001), there were no significant differences in functional outcomes between the two groups. In the nonoperative group, three patients underwent osteosynthesis for symptomatic nonunion. There were no significant differences in radiological and functional outcomes between the two subgroups divided by fixation method. In a pediatric medial epicondylar fracture with a displacement of >5 mm as accurately measured on 3D CT, despite the difference in union rate, there was no difference in functional outcomes between operative and nonoperative treatment. Performing CT only to measure the fracture displacement in obviously displaced medial epicondylar fracture is not considered as a part of the “necessary” diagnostic workups.

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“…On the other hand, some authors have reported cases of painful nonunion and functional impairment after cast immobilization 8 . According to Shukla et al, medial epicondylar nonunion could be cause of valgus instability, especially in high demanding patients like gymnasts and throwing athletes 9,10 . Advocates of operative treatment sustain that surgical treatment of displaced fractures has the advantage to allow an anatomic reduction, guaranteeing a high union rate and preventing elbow instability 11 .…”

Section: Discussionmentioning

confidence: 99%

Displaced medial epicondyle fractures: retrospective study and review of the literature

et al. 2020

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Objective. To present the clinical and functional results of medial epicondylar fractures in 24 surgically-treated children with long-term follow-up. Methods. We retrospectively reviewed 24 cases of displaced medial epicondylar fracture surgically treated between January 2013 and December 2016. Demographical characteristics of patients were recorded and analyzed along with radiographical images. Patients underwent clinical evaluation and were asked to answer to the Quick DASH test to assess long term functional outcome. Results. Mean follow-up was 4.8 years. Complete range of movement of the elbow was restored in all cases except for 4 cases of extension lag inferior to 30° and 2 cases of slightly reduced pronation. Valgus deformity of the elbow inferior to 15° was observed in 3 patients. Mean Quick DASH score was 15.1. Conclusions. Even if the treatment guidelines of displaced medial epicondyle fractures are still debated, our study demonstrates satisfying functional results in the long term after surgical treatment, without major complications. In addition, surgery allows anatomic reduction of the fracture, preventing fibrous nonunion.

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Medial Epicondyle Nonunions in Children: Case Report With Overview and Management

Cited by 6 publications

References 17 publications

Resorbable magnesium screws for fixation of medial epicondyle avulsion fractures in skeletally immature patients: A comparison with Kirschner wires

Resorbable magnesium screws for fixation of medial epicondyle avulsion fractures in skeletally immature patients: A comparison with Kirschner wires

Is Computed Tomography Necessary for Diagnostic Workup in Displaced Pediatric Medial Epicondyle Fractures?

Displaced medial epicondyle fractures: retrospective study and review of the literature

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