Pediatric Medial Epicondyle Fractures Are We There Yet?

Several controversies surround the evaluation and treatment of medial epicondyle fractures of the humerus in children. As is well established, the medial epicondyle is the point of attachment for the medial collateral ligament and flexor and pronator musculature, thereby conferring a potentially important role in elbow stability and wrist strength. Traditional x-ray evaluation has been shown to be inaccurate in measuring fracture displacement. While novel radiographic views or advanced imaging modalities may improve this accuracy, the role of displacement in guiding treatment decisions remains unclear. Previous literature on medial epicondyle fractures-all of which is level III or IV evidence-suggests that outcomes may be similar between operative and non-operative treatment. However, most studies are hamstrung by inadequate power, potential for bias, or evaluation of antiquated surgical techniques. In the face of these uncertainties, a shared decision should be made with the patient and family after thorough consideration of treatment goals and discussion of the benefits and disadvantages of both surgical and non-surgical care. Prospective studies are underway and hope to provide clarity on the many debates surrounding this injury.