Nonoperative Management of Sublime Tubercle Fractures in Adolescent Throwing Athletes: Improved Results With Cast...

Avulsion fractures of the sublime tubercle of the ulna are a cause of medial elbow pain and instability in overhead athletes.

To compare outcomes after sublime tubercle avulsion fracture managed as a fracture (with cast immobilization) versus a soft tissue injury (without immobilization and with early range of motion [ROM]) to determine how to achieve the best outcomes for these injuries in adolescent throwing athletes.

Cohort study; Level of evidence, 3.

A multicenter retrospective review using an institutional database query of radiology reports to identify sublime tubercle fractures between July 2005 and December 2020 was performed. Inclusion criteria were baseball players aged ≤19 years, fracture identified on ≥1 imaging study (radiograph, computed tomography, or magnetic resonance imaging), and ≥24 months of follow-up (unless failure of management occurred earlier). Fractures were classified as simple or complex injuries and then grouped according to management strategy: cast or early ROM. Data collected included patient characteristics, clinical presentation (injury mechanism and acuity), initial treatment, and outcomes (complications, final ROM, patient-reported symptoms, radiographic union, and return to activities or sport).

A total of 13 baseball players (6 in the cast cohort and 7 in the early ROM cohort) with a mean age of 16.5 years (range, 15-19 years) met the inclusion criteria, with a mean follow-up of 4.1 years (range, 2.0-6.7 years) in the cast cohort and 3.8 years (range, 2.1-7.4 years) in the early ROM cohort. All injuries were classified as simple fractures. Five patients (83%) in the cast cohort achieved radiographic union, return to sports, and symmetric ROM, compared with only 2 patients (29%) in the early ROM cohort who achieved the same without having to undergo ulnar collateral ligament reconstruction (P = .026).

The present study demonstrated that, whereas management of sublime tubercle avulsion fractures in adolescents via early ROM had a high failure rate, a mean of 4 weeks of immobilization led to a high rate of return to sports with successful union of the avulsed fragment. Unlike purely ligamentous injuries, bony avulsions may not necessarily require surgical intervention for adolescent patients to return to baseball.