Outcomes of Nonoperative Pediatric Medial Humeral Epicondyle Fractures With and Without Associated Elbow Dislocation

Knapik, Derrick M.; Fausett, Cameron L; Gilmore, Allison; Liu, Raymond W.

doi:10.1097/bpo.0000000000000890

Cited by 41 publications

(25 citation statements)

References 29 publications

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“…10 A review article by Kapok et al titled as outcomes of non-operative treatment of medial epicondyle fractures in children with and without associated elbow dislocation opined that increased rates of non-union, stiffness and elbow laxity may be associated with nonsurgical treatment of fractures with dislocation and needed further validated studies. 11 Our study indirectly proves the point raised by this study. We showed that clinical results are excellent when medial epicondyle fractures are surgically fixed even in cases of associated dislocation.…”

Section: Discussionsupporting

confidence: 75%

Medial epicondyle fractures in children: a study of functional outcome of surgical fixation

2018

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Background: Medial epicondyle fracture is a common elbow injury in children. It is associated with elbow dislocation in many cases. Treatment of displaced medial epicondyle fracture with and without elbow dislocation is a debated topic. Surgical and non surgical methods are practiced with variable results.Methods: Our study was a prospective study of medial epicondyle fractures treated by surgical fixation with k wires. We studied total of 24 cases out of which 15 had elbow dislocation. The study period was from 2012 to 2015 and indications for surgery were displacement more than 5 mm, elbow instability, incarceration of fragment, ulnar nerve irritation. Open reduction and internal fixation with K wire done. We used joystick method while reducing the fragment with k wire which was a great help. We assessed the cases using mayo elbow performance score.Results: Our study yielded excellent results in 92% of patients (mayo elbow performance score >90). There was no major difference in clinical outcome between two groups of patients. Complications like instability and non-union not seen following surgical fixation with K wires. The mean loss of flexion, extension, supination, and pronation was 4, 5, 3 and 2 degrees respectively with elbow dislocation group and 2, 3, 1, 1 in without dislocation group. Pre op instability seen in 54% patients was absent in follow up period. Stiffness was more in elbow dislocation group but overall performance was almost equal.Conclusions: Surgical fixation of medial epicondyle fractures yields excellent results and may be advisable when indicated.

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Section: Discussionsupporting

confidence: 75%

Medial epicondyle fractures in children: a study of functional outcome of surgical fixation

2018

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“…Operative fixation has been found to be superior to non-operative treatment in cases of medial epicondyle fracture among patients with elbow dislocation according to a recent study of 498 patients [22]. Regardless of fracture union rate, clinical or functional disabilities seem to be minimal after non-operative treatment of medial epicondyle fracture with or without associated elbow dislocation [8]. In general, the aim of operative treatment in cases of elbow dislocation with an associated fracture is to maximize an early return to daily mobilization and high-level activity [22].…”

Section: Discussionmentioning

confidence: 99%

“…As another weakness, the fractures were diagnosed by radiographs, possibly resulting in the fact that not all osteochondral fractures were found. Magnetic resonance imaging was not performed in the cohort [25] due to practical reasons [8]. As a strength, this is the only study concerning the incidence and recent trend in childhood elbow dislocation in a normal child population since the 1980s, to best of our knowledge.…”

Section: Discussionmentioning

confidence: 99%

“…Other bone fractures associated with the dislocation are at lateral humeral condyle, radial head, olecranon and coronoid process of the ulna [5]. Prompt reduction and external splint immobilization of a simple elbow dislocation are associated with good results [2, 5–8]. A displaced fracture, however, may indicate surgical fixation to hold the joint congruent [3, 5, 9].…”

Section: Introductionmentioning

confidence: 99%

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Recent trends in children's elbow dislocation with or without a concomitant fracture

Hyvönen

Korhonen

Hannonen

et al. 2019

BMC Musculoskelet Disord

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Background The elbow is the joint that most usually dislocates in children. In contrast to the widely known recent increase in the incidence of upper-extremity fractures and their operative treatment in children, potential trends in elbow dislocation are not clear. In this study we aimed to clarify the recent epidemiology of childhood elbow dislocation, in particular the potential change in incidence and treatment. Methods A population-based study was performed to evaluate the annual incidence and the characteristics of injury, patients and treatment. All children < 16 years of age with an elbow dislocation in 1996–2014 in the Oulu University Hospital District, Finland, were included. Elbow dislocations with and without an associated fracture were included. The mean number of children in the population at risk was 85,600, according Statistics Finland. Results There were 104 patients with a mean age of 11.3 years (SD 2.6). The annual incidence was 6.4 (mean) per 100,000 children in 1996–2014 and no changing trend in incidence during the study period was found. Trampoline jumping was the most usual reason for the dislocations ( N = 15, 14.4%). The majority ( N = 73/104, 70.2%) were treated non-operatively by reduction and casting. There was no change in surgical treatment during the study time. Conclusion In contrast to increasing incidence of upper-extremity fractures in children, there has not been a change in the incidence of elbow dislocation in children. There was no change in surgical treatment in 1996–2014.

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“…Medial epikondil kırıklarının tedavisi güncel literatürde halen tartışılmaktadır (3,(5)(6)(7)(8). Açık kırıklar ve medial epikondilin dirsek eklem içine inkarserasyonu cerrahi için kesin endikasyonlar olarak bildirilmiştir (1,2).…”

Section: Introductionunclassified

Mid-term Clinical and Radiological Results of Surgically Treated Pediatric Medial Humeral Epicondyle Fractures: Screw or K Wire?

Onay¹,

Okay²

2018

BTDMJB

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Objective: The aim of the present study was to evaluate the clinical and radiological results of surgically treated pediatric medial humeral epicondyle fractures which were fixed with screw or K wire. Materials and Methods: The study was designed retrospectively. Twenty two patients were evaluated clinically and radiologically. Functional outcomes were assessed with the Mayo elbow performance index (MEPI) and the Turkish language version of the shortened version of the Disabilities of Arm, Shoulder, and Hand (Quick DASH) scale. Results: All fractures were healed. The mean MEPI was 99.3 points (range, 85-100), with 21 patients as excellent and 1 good results. The mean MEPI was 100 points for patient who was fixed with K wires (group A). Excellent results were obtained for all patients. The mean MEPI was 97.9 points (range, 85-100) for patients with screw fixation (group B). Excellent results were obtained for all patients, except one. The mean Quick DASH score was 0.63 (range, 0-9). It was found 0.33 (range 0-5) and 1.3 (range, 0-9) for group A and group B, respectively. Two (13%) minor complications were developed in group A and 4 (57.3%) in group B. The difference for Quick DASH and MEPI scores were statistically insignificant (p>0.05). Conclusion: Both of fixations with K wire or screw provide enough stability until the fracture healed. Fracture union could be obtained for both fixation type and the clinical and radiological results were similar. The need for secondary operation for implant removal and higher complication rates seems the negative side of screw fixation.

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Outcomes of Nonoperative Pediatric Medial Humeral Epicondyle Fractures With and Without Associated Elbow Dislocation

Abstract: Level II-systematic review of level-II or level-I studies with inconsistent results.

Cited by 41 publications

References 29 publications

Medial epicondyle fractures in children: a study of functional outcome of surgical fixation

Medial epicondyle fractures in children: a study of functional outcome of surgical fixation

Recent trends in children's elbow dislocation with or without a concomitant fracture

Mid-term Clinical and Radiological Results of Surgically Treated Pediatric Medial Humeral Epicondyle Fractures: Screw or K Wire?

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