O1065: Medial Epicondyle Fractures in Children: Operative versus Non-operative Treatment

Background: Medial epicondyle fractures (MEF) are a common pediatric injury, however there is little consensus as to ideal treatment. Historically, most treatment has been non-operatively with cast or splint immobilization, however increasingly these injuries are being treated with surgical intervention. We aimed to evaluate trends in the management of MEF at our institution and compare outcomes of operative and non-operative groups.

Methods: A single-center tertiary care departmental database was queried to identify patients who underwent treatment for MEF between 2003 and 2019. Children who underwent conservative treatment were compared with those who underwent surgical intervention. Clinical, demographic, and radiologic data were analyzed.

Results: Eight hundred twenty-five fractures were identified (53% female, mean age 11.7 years), of which 550 (67%) were treated with surgical intervention and 275 (33%) were treated conservatively. There was a modest trend toward increased surgical treatment over time. Surgical patients were found to be older (mean 12.1 vs 10.8 years), had a shorter time from injury to presentation, more nerve changes (10% versus 2%), more elbow dislocations (46% versus 16%), a greater proportion of entrapped fragments (17% versus 0%), and had increased fracture displacement on AP Xray (median 8mm versus 3mm). In the surgical cohort, 47/550 (9%) of patients experienced at least one complication, with 21/550 (4%) of patients requiring a secondary procedure due to a complication. Surgical procedures performed in the supine position took an average of 84.2 minutes while those in the prone position took an average of 76.0 minutes (p < 0.001). Multivariable analysis found no associations between patient, injury, or treatment characteristics and the likelihood of surgical complication. In the non-surgical group, bony union was not present at final radiographic follow-up in 64% of fractures. Multivariable analysis found no associations between patient, injury, or treatment characteristics and the likelihood of nonunion in this group.

Conclusion: The results of this study suggest that multiple demographic and treatment variables influence the decision for conservative versus surgical management of MEF. Further, the risk of complications appears to be related to characteristics of the injury (displacement amount, elbow dislocation, paresthesias) and not based on treatment type. The findings of this study highlight the need for future randomized studies to better determine whether surgery or conservative treatment leads to improved outcomes after MEF.