What's New in Pediatric Medial Epicondyle Fractures?

BACKGROUND: Medial epicondyle fractures are predominantly seen in adolescent, male patients. Historically, nonoperative intervention was the mainstay of treatment. With increasing upper extremity demands of young athletes and reports of valgus instability after nonoperative treatment, there has been an increased interest in operative indications. Controversy regarding proper imaging and measurement of displacement complicates decision-making algorithms. Review of recent literature is required for improved decision making.

METHODS: We searched the PubMed database for all papers related to the treatment of medial epicondyle fractures in patients under 18 years of age published between January 1, 2005 and March 15, 2016. This resulted in 39 papers written in English for review. Papers were included based upon subject matter and contribution of new findings to literature. Review articles were excluded.

RESULTS: In total, 39 papers were reviewed and 30 were included in this review. Five classic manuscripts on medial epicondyle fractures in children provide appropriate historical and background information as needed.

CONCLUSIONS: Medial epicondyle fractures represent a variety of low and high-energy mechanisms, displacement, treatment options, and complications. This paper reviews recent literature on these topics. Controversy regarding imaging modality, displacement measurement accuracy, and surgical indications still exist. Long term, patient based, functional outcome studies of operative versus nonoperative treatment are needed to improve our treatment algorithms of this injury. Treatment algorithms should be individualized to each specific patient and fracture.

LEVEL OF EVIDENCE: Level 5.