Symptomatic medial humeral epicondylar fracture non-union- rare presentation of a relatively common injury

Kulkarni, Vidisha; Arora, Nikhil; Gehlot, Harshit; Saxena, Sagar; Kulkarni, Shreyas; Bajwa, Supreet

doi:10.1016/s0020-1383(17)30494-1

Cited by 12 publications

(6 citation statements)

References 19 publications

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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%

“…Moreover, some of the other patients showing nonunion may develop symptoms later in life. A case study reported the long-standing symptomatic nonunion of the medial epicondyle in the adult population [ 23 ] for those whose injuries occurred in childhood. It should be noted that symptomatic nonunion could be a potential problem.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical treatment was optimal to achieve the bone union in all patients. Unlike osteosynthesis for symptomatic nonunion [ 23 ], the surgery for medial epicondyle fracture is simple. However, surgical treatment may not be cost-effective, and the NNT operatively to prevent one symptomatic nonunion was seven.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Kim

Park

et al. 2020

Diagnostics

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“…Dicho tratamiento es variable en función del tiempo de evolución y puede incluir la necesidad de transposición del nervio cubital, alargamiento miofascial del complejo flexor-pronador, reconstrucción del ligamento colateral cubital e incluso la eliminación de calcificaciones heterotópicas. 55,56 Se desconoce el porcentaje real de pseudoartrosis sintomáticas, aunque se sabe que es muy infrecuente. No obstante debe considerarse una complicación grave y más propia del grupo de tratamiento conservador, que podría por sí sola justificar el tratamiento quirúrgico inicial de la fractura para evitar su aparición.…”

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Fracturas controvertidas de miembro superior en niños y adolescentes: un debate basado en la evidencia

Taverner¹,

Halliburton²,

Alfaro³

et al. 2022

Revista Mexicana De Ortopedia Pediátrica

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Despite the high incidence of pediatric upper extremity fractures, there is still much debate on optimal management. In a webinar recently organized by the Sociedad Española de Ortopedia Pediátrica (SEOP) in conjunction with the Sociedad Argentina de Ortopedia y Traumatología Infantil (SAOTI), the evaluation and principles of treatment of five controversial upper extremity fractures were discussed. The aim of this special article is to provide readers with a summary of the evidence-based arguments used in that session.

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“…The treatment of pediatric medial epicondyle fractures is controversial, with good results from both nonoperative and operative management. 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 In a classic study, nonoperative treatment of 56 medical epicondyle fractures with 35 years of follow-up showed good results despite 31 cases of pseudarthrosis. 16 The understanding of the medial elbow structures such as the flexor-pronator mass and ulnar collateral ligament with its complex role in valgus stability of the elbow has since evolved.…”

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confidence: 99%

Long-Term Outcomes of Operatively Treated Medial Epicondyle Fractures in Pediatric and Adolescent Patients

Patel

Tarkunde

Wall

et al. 2021

Journal of Hand Surgery Global Online

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Medial epicondyle fractures are among the most common pediatric elbow injuries. The management of these fractures continues to be debated. To better understand patient results with operative fixation, we reviewed the outcomes of operatively treated medial epicondyle fractures. Methods: A retrospective review was performed to identify all patients less than 18 years of age at the time of injury who were treated surgically for medial epicondyle fractures. Outcomes were assessed based on the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity and Pain Interference domains, Visual Analog Scale for pain, subjective range of motion, ulnar nerve function, and requirement for secondary surgery. Results: We identified a cohort of 95 patients treated for a medial epicondyle fracture with open reduction and screw fixation. Of these, 39 patients with a mean age of 12.2 years (SD, 2.2 years; range, 7.6 e16.0 years) at surgery were assessed for an average follow-up of 6.3 years (SD, 3.2 years; range, 2.2 e13.9 years). Outcome measures and pain scores were excellent. The mean PROMIS Upper Extremity score was 56.9, the mean Pain Interference score was 38.5, and the mean Visual Analog Scale score was 0.4.Sixteen patients (41%) required secondary surgery for symptomatic hardware removal. Seven patients (18%) developed sensory complaints and 2 (5%) developed motor complaints consistent with ulnar nerve irritability. Three patients (8%) reported dissatisfaction with elbow range of motion. Patients who required secondary surgeries had higher (worse) PROMIS Pain Interference scores. Conclusions: At an average of 6.3 years after surgery, the clinical outcomes for medial epicondyle fracture were excellent. While operative treatment for medial epicondyle fractures in children leads to excellent clinical outcomes, patients and surgeons should be aware of high rates of hardware removal. Type of study/level of evidence: Therapeutic IV

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Symptomatic medial humeral epicondylar fracture non-union- rare presentation of a relatively common injury

Cited by 12 publications

References 19 publications

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

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

Fracturas controvertidas de miembro superior en niños y adolescentes: un debate basado en la evidencia

Long-Term Outcomes of Operatively Treated Medial Epicondyle Fractures in Pediatric and Adolescent Patients

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