This study is a retrospective long-term follow-up on pediatric medial humeral epicondyle avulsion fractures treated with either cast immobilization, open reduction and internal fixation (ORIF), or excision alone. 42 patients returned for clinical and radiographic evaluation out of 104 patients initially treated. The average age at treatment was 12 years (range, 8 – 15 years). Patients were evaluated at an average of 45 years (range, 30 - 61 years). Displacement of the medial epicondyle ranged between 5 – 15 mm, with an average range of 10mm. Internal fixation was performed either with Kirschner wires or with a T-nail. In the excision group, the tendon origin and medial collateral ligament were suture repaired to the periosteum.
Immobilization in a long arm cast at 90 degrees was performed in all groups for 4 weeks. Subjective, functional, and clinical evaluation were similar for the cast immobilization group and ORIF group. The radiographic evaluation, however, revealed that 17 of 19 patients had a persistent non-union in the immobilization group, whereas, all 17 patients treated with ORIF had a healed but irregularly shaped epicondyle. No patient in either group exhibited elbow instability regardless of the healing status of the medial epicondyle. Only 6 patients were treated with medial epicondyle excision. Four of the 6 had excision due to fragmentation during attempted ORIF. In this group, 2 patients had a fair result and 4 patients had a poor result. Most of these patients had constant pain at the elbow joint with evidence of persistent ulnar neuropathy and persistent elbow instability to valgus stress.
This long-term study shows similar results for cast immobilization or ORIF for displaced medial epicondyle fractures greater than 5mm. Although most patients treated with cast immobilization went onto a non-union, none of these patients exhibited instability or inferior results at long-term follow-up. Although the authors report that the patients had similar athletic experience following the injury, they specifically did not comment on the number of patients that actually engaged in throwing or overhead sports. Furthermore, 60% of cases were lost to follow-up making conclusions somewhat difficult. The poor results in this study were only found in patients with medial epicondyle excision which should be avoided in children.