Publication:

Medial epicondyle fractures in children: a study of functional outcome of surgical fixation

Background Medial epicondyle fracture is a common elbow injury in children. It is associated with elbow dislocation in many cases. Treatment of displaced medial epicondyle fracture with and without elbow dislocation is a debated topic. Surgical and non surgical methods are practiced with variable results.

Methods Our study was a prospective study of medial epicondyle fractures treated by surgical fixation with k wires. We studied total of 24 cases out of which 15 had elbow dislocation. The study period was from 2012 to 2015 and indications for surgery were displacement more than 5 mm, elbow instability, incarceration of fragment, ulnar nerve irritation. Open reduction and internal fixation with K wire done. We used joystick method while reducing the fragment with k wire which was a great help. We assessed the cases using mayo elbow performance score.

Results Our study yielded excellent results in 92% of patients (mayo elbow performance score >90). There was no major difference in clinical outcome between two groups of patients. Complications like instability and non-union not seen following surgical fixation with K wires. The mean loss of flexion, extension, supination, and pronation was 4, 5, 3 and 2 degrees respectively with elbow dislocation group and 2, 3, 1, 1 in without dislocation group. Pre op instability seen in 54% patients was absent in follow up period. Stiffness was more in elbow dislocation group but overall performance was almost equal.

Conclusions Surgical fixation of medial epicondyle fractures yields excellent results and may be advisable when indicated.