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Does operative fixation affect outcomes of displaced medial epicondyle fractures?
Matthew Stepanovich1, Tracey P Bastrom2, John Munch2
1Naval Medical Center Portsmouth, Portsmouth, VA, USA.
Insights
Operative fixation of displaced humeral medial epicondyle fractures leads to better fracture union and return to sports compared to nonoperative management. Functional outcomes were similar between groups in this small study.
Area of Science:
- Orthopedic surgery
- Traumatology
- Sports medicine
Background:
- Displaced medial epicondyle fractures of the humerus present treatment challenges.
- Long-term functional outcomes comparing operative fixation and closed management remain unclear.
Purpose of the Study:
- To compare functional outcomes between operative and nonoperative treatment for displaced humeral medial epicondyle fractures.
Main Methods:
- A cohort of 140 patients with displaced medial epicondyle fractures was identified.
- A subset of 12 patients underwent prospective evaluation at a mean 3-year follow-up.
- Data included radiographs, physical examination, validated outcome tools, and grip strength testing.
Main Results:
- Operative and nonoperative groups showed similar patient satisfaction and elbow function scores.
- The nonoperative group had significantly higher rates of nonunion (67%) and malunion (17%) compared to the operative group (p=0.015).
- Grip strength showed a nonsignificant decrease in the nonoperative group.
Conclusions:
- Operative management resulted in a higher rate of fracture union and return to sports.
- Objective and subjective functional measures were comparable between operative and nonoperative treatments in this limited cohort.
Purpose:
Long-term functional results remain equivocal between operative fixation and closed management of displaced humeral medial epicondyle fractures. The purpose of this study was to determine whether a functional difference exists between treatment types.
Methods:
One hundred and forty patients with a displaced medial epicondyle fracture between 2007 and 2014 met the inclusion criteria. Of this large cohort, only 12 patients agreed to return to clinic at a mean follow-up of 3 years for prospective evaluation. Data collection included radiographs, physical examination, validated outcome tools, and grip strength testing with a Jamar dynamometer.
Results:
Both groups were comparable with regard to age, dominant side injured, length of follow-up, preinjury sports involvement, and initial displacement (10 mm operative vs. 9 mm nonoperative); however, half of the surgical group presented with an associated unreduced elbow dislocation versus 0 % in the nonoperative group. Both treatment methods resulted in high patient satisfaction and elbow function scores. There were four osseous nonunions (67 %) and one malunion (17 %) in the nonoperative group versus none in the operative group (p = 0.015). Patients treated nonoperatively had a nonsignificant decrease in grip strength (9 ± 6 lbs) as compared to operative patients (6 ± 5 lbs, medium effect size eta = 0.25, p = 0.25).
Conclusions:
In this small cohort, operative management of displaced medial epicondyle fractures resulted in a higher rate of fracture union and return to sports. Other objective and subjective measures were similar between the two treatment groups.
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