Displaced fractures of medial epicondyle. A systematized bibliographic review
Abstract
Introduction:
fractures of medial epicondyle represent 12 to 20% of pediatric elbow fractures. Treating fractures with greater than 2 mm of displacement is a matter of debate. The study aims to review indications and results of the different treatments indicated for fractures of medial epicondyle with greater than 2 mm of displacement.
Method:
the PubMed and Bireme electronic data bases were used. Search revealed 313 articles, 9 of which met the inclusion criteria set upon initiation of the study.
Discussion:
imaging techniques used and their diagnostic yield were compared, as well as the different of treatments and complications.
Conclusion:
treatment should not be defined based on the fracture’s displacement, but rather on the trauma energy and the valgus stability of the elbow. Excellent results were reported both with a conservative treatment and with a surgical approach to displaced fractures of medial epicondyle. Comparative studies need to be done with long term follow-up that is well recorded to recommend the right treatment for displaced fractures of medial epicondyle.
References
(1) Morrey B. The Elbow and Its Disorders. 3rd.ed. Philadelphia (PA): Saunders, 2004.
(2) Skaggs DL, Kocher MS. Master Techniques in Orthopaedic Surgery: Pediatrics. 2nd.ed. Philadelphia (PA): Wolters Kluwer, 2016.
(3) Josefsson PO, Danielsson LG. Epicondylar elbow fracture in children. 35-year follow-up of 56 unreduced cases. Acta Orthop Scand 1986; 57:313-5.
(4) Lim KB, Woo CY, Chong XL, Ul-Alam S, Allen JC. The isolated medial humeral epicondyle fracture treated nonoperatively: does fracture displacement change over time? J Pediatr Orthop B 2015; 24(3):184-90.
(5) Lawrence JT, Patel NM, Macknin J, Flynn JM, Cameron D, Wolfgruber HC, Ganley TJ. Return to competitive sports after medial epicondyle fractures in adolescent athletes: results of operative and nonoperative treatment. Am J Sports Med 2013; 41(5):1152-7.
(6) Farsetti P, Potenza V, Caterini R, Ippolito E. Long-term results of treatment of fractures of the medial humeral epicondyle in children. J Bone Joint Surg Am 2001; 83(9):1299-305.
(7) Park KB, Kwak YH. Treatment of medial epicondyle fracture without associated elbow dislocation in older children and adolescents. Yonsei Med J 2012; 53(6):1190-6.
(8) Biggers M, Bert T, Moisan A. Fracture of the medial humeral epicondyle in children: A comparison of operative or non operative management. J Surg Orthop Adv 2015; 24(3):188-92.
(9) Pace GI, Hennrikus WL. Fixation of displaced medial epicondyle fractures in adolescents. J Pediatr Orthop 2016; 37(2):e80-e82.
(10) Louahem DM, Bourelle S, Buscayret F, Mazeau P, Kelly P, Dimeglio A, et al. Displaced medial epicondyle fractures of the humerus: surgical treatment and results. A report of 139 cases. Arch Orthop Trauma Surg 2010; 130(5):649-55.
(11) Edmonds EW. How displaced are "nondisplaced" fractures of the medial humeral epicondyle in children? Results of a three-dimensional computed tomography analysis. J Bone Joint Surg Am 2010; 92(17):2785-91.
(12) Shukla SK, Cohen MS. Symptomatic medial epicondyle nonunion: treatment by open reduction and fixation with a tension band construct. J Shoulder Elbow Surg 2011; 20(3):455-60.
