Long-term results of treatment of fractures of the medial humeral epicondyle in children

Background: The treatment of isolated, displaced fractures of the medial hu meral epicondyle in children is controversial. Both plaster cast immobiliza tion without reduction and open reduction and internal fixation have been a dvocated. The purpose of this long-term retrospective study was to analyze the functional and radiographic results of both nonsurgical and surgical ma nagement of these injuries. Methods: Forty-two patients who had had an isolated fracture of the medial humeral epicondyle with displacement of >5 mm at an average age of twelve y ears (range, eight to fifteen years) were evaluated at an average age of fo rty-five years (range, thirty to sixty-one years). The patients were divide d into three groups that were comparable with regard to the amount of fract ure displacement, age at the time of the fracture, age at the time of follo w-up, sports activities and occupation, and duration of follow-up. In Group I (nineteen patients), the fracture had been treated with a long-arm plast er cast without reduction of the displaced medial epicondyle. In Group II ( seventeen patients), open reduction and internal fixation with either Kirsc hner wires or a T-nail had been performed. In Group III (six patients), the epicondylar fragment had been excised with suture reattachment of the tend ons and the medial collateral ligament. Results: According to a functional grading scale, there were sixteen good a nd three fair results in Group I. All but two patients were seen to have no nunion of the fragment on follow-up radiographs, but all had a normal resul t on valgus stress-testing of the elbow. The range of motion of the elbow w as either normal or minimally decreased, and the grip strength of the ipsil ateral hand was normal. There were fifteen good and two fair results in Gro up II. All patients had union of the medial epicondyle, with various radiog raphic deformities of the medial epicondyle, but the functional results wer e similar to those of the Group-I patients. The Group-III patients had four poor and two fair results. Four had constant pain at the elbow and paresth esias in the distribution of the ulnar nerve. One patient had a restricted range of motion of the elbow, four patients had an unstable elbow, and thre e patients had decreased grip strength of the ipsilateral hand. Conclusions: In our study, nonsurgical treatment of isolated fractures of t he medial humeral epicondyle with between 5 and 15 mm of displacement yield ed good long-term results similar to those obtained with open reduction and internal fixation. The nonunion of the epicondylar fragment that was prese nt in most patients who had been treated only with a cast did not adversely affect the functional results. Surgical excision of the medial epicondylar fragment should be avoided because the long-term results are poor.