Type four fracture of the medial epicondyle: a true indication for surgical intervention

Fourteen consecutive eases with type 4 fracture of the medial epicondyle we re evaluated following open reduction and internal fixation of the displace d medial epicondyle. The mean age was 9.7 years (range 6-16) and the mean f ollow-up was 17.2 months (range 12-24). Operative treatment yielded excelle nt results with no loss of functional range of motion, residual deformity o r instability. There were three cases with pre-operative symptoms of ulnar nerve injury which made a good recovery following neurolysis of the ulnar n erve. Type 4 fractures are commonly associated with intra-articular entrapm ent of the ulnar nerve and result from serious damage to the soft tissues o n the medial side of the elbow. Assessing instability is therefore of key i mportance, as is the intra-operative gravity stress-valgus test in assessin g instability. (C) 1998 Elsevier Science Ltd. All rights reserved.