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Fracture of the Medial Humeral Epicondyle in Children: A Comparison of Operative and Nonoperative Management
Insights
Operative versus nonoperative treatment for medial epicondylar fractures yields similar good outcomes for displaced fractures. However, nonoperative care may lead to more radiographic deformity and instability.
Area of Science:
- Orthopedic Surgery
- Traumatology
- Elbow Fractures
Background:
- Medial epicondylar fractures are common elbow injuries.
- Treatment decisions involve operative versus nonoperative approaches.
- Outcomes can vary based on fracture displacement and incarceration.
Purpose of the Study:
- To compare clinical and radiographic outcomes of operative versus nonoperative treatment for medial epicondylar fractures.
- To evaluate the impact of fracture displacement and incarceration on treatment success.
Main Methods:
- Retrospective review of 31 medial epicondylar fractures in 30 patients.
- Classification into nondisplaced, incarcerated, and displaced (non-incarcerated) groups.
- Clinical assessment using follow-up examination and the Japanese Orthopaedic Association (JOA) elbow score.
- Radiographic evaluation for deformity and instability.
Main Results:
- All groups achieved high JOA elbow scores (94-98).
- Nonunion occurred only in a fracture with an incarcerated fragment.
- Displaced, non-incarcerated fractures showed good outcomes with both operative and nonoperative treatment.
- Nonoperative treatment for displaced fractures resulted in higher rates of radiographic deformity and instability.
Conclusions:
- Both operative and nonoperative management can yield satisfactory clinical outcomes for displaced medial epicondylar fractures.
- Nonoperative treatment of displaced fractures may increase the risk of radiographic abnormalities.
- Fractures with incarcerated fragments warrant careful consideration due to potential for nonunion.
Abstract:
To compare clinical and radiographic outcomes of medial epicondylar fractures treated operatively to those treated nonoperatively, 30 patients with 31 fractures were divided into three groups: (a) nondisplaced, six treated nonoperatively; (b) incarcerated fragment, four with operative treatment; and (c) displaced but not incarcerated, 21 fractures, 14 treated operatively and seven nonoperatively. Clinical outcomes were assessed with follow-up examination and the Japanese Orthopaedic Association elbow assessment score. Average elbow scores were 98 in nondisplaced fractures, 94 with an incarcerated fragment, 95 in displaced fractures treated operatively, and 94 in displaced fractures treated nonoperatively. The only nonunion was in a fracture with an incarcerated fragment. Both operative and nonoperative treatment produced good outcome scores in displaced but not incarcerated fractures, but radiographic deformity and instability were more frequent in those treated nonoperatively.
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