Session VI - Pediatrics / Spine

Fri., 10/11/13 Pediatrics/Spine, PAPER #70, 4:07 pm OTA 2013

Displaced Medial Epicondyle Fractures in Children: Comparative Effectiveness of Surgical Treatment Versus Nonsurgical Treatment

Emily Mayer, BS; Charles T. Mehlman, DO, MPH;
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

Purpose: The purpose of this study was to assess the comparative effectiveness of surgical versus nonsurgical treatment for pediatric patients with acute, displaced medial epicondyle fractures.

Methods: This retrospective, comparative study included 56 children (31 female, 25 male) under age 18 years with an acute, displaced medial epicondyle fracture treated between 2000 and 2011 and with at least 1 year clinical follow-up. Medical records were searched for demographic, surgical, and functional data (range of motion, pain, symptoms, and limitations). Displacement was measured on radiographic injury films. Patients were contacted by phone for completion of the validated QuickDASH (an abbreviated version of the Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire. Outcomes of surgical and nonsurgical treatment were compared using Mann-Whitney and Fisher exact tests and linear regressions controlling for age and maximum displacement.

Results: Of the 56 patients (mean age, 11 years; range, 4-17) with displaced medial epicondyle fractures, 41 were treated surgically and 15 nonsurgically. The surgically treated patients were older (12.0 vs 9.6 years, P = 0.036), had greater maximum displacement (11.0 vs 7.9 mm, P = 0.011), and shorter immobilization (3 vs 4 weeks, P = 0.014) than the nonsurgically treated patients. The two groups did not differ in range of motion, pain, or patient-reported functional outcomes at most recent follow-up (P >0.05). Fracture dislocations occurred in 41% (17 of 41) of surgically treated and 33% (5 of 15) nonsurgically treated patients. Patients with dislocated fractures were more likely to have long-term functional disability, regardless of age, maximum displacement, or treatment (P = 0.040). Complications occurred in 53% of patients (8 of 15) in the nonsurgical group and included arthofibrosis, two ulnar neuropathies, three refractures, and three nonunions. Seven nonsurgically treated patients advanced to surgical treatment within 3 years, and five had residual functional limitations.

Conclusion: Our findings demonstrate a high failure rate (47%) of nonsurgically treated medial epicondyle fractures. Nonsurgical treatment is only recommended for fractures without elbow dislocation that do not contain an intra-articular fragment.

Alphabetical Disclosure Listing

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.