Interhospital Variability in Treatment of Pediatric Medial Epicondyle Fractures of the Humerus

Fractures of the medial humeral epicondyle are common, yet there is no consensus on the most effective treatment method. Both casting alone and open reduction with internal fixation have been shown to promote reliable healing, but there is limited evidence supporting the superiority of either approach. The aim of this study is to assess the variation in treatment approaches for MEF and to identify which patient characteristics or hospital factors influence a surgeon's decision to perform surgery.

We conducted a retrospective cohort study to evaluate treatment variations between operative and non-operative management of medial epicondyle fractures (MEF) in children. The study cohort was drawn from 44 participating US hospitals using the Pediatric Health Information System (PHIS) database. We included children aged 8-18 years who were diagnosed with a MEF and discharged between 2011 and 2015.

On average, patients were treated operatively 58.8% of the time (range 21%-92%). Our adjusted model for race, ethnicity, payment type and hospital census showed that children aged 12-15 year old had increased odds of operative treatment compared to those aged 8-11 (odds ratio (OR) 1.43, 95% confidence interval (CI) [1.22, 1.66]). White children (OR 1.41, 95% CI [1.12, 1.78]), non-Hispanics (OR 1.56, 95% CI [1.22, 2.00]), and those with private insurance (OR 1.33, 95% CI [1.12, 1.59]) were all more likely to be treated operatively when compared to those who were Black, Hispanic, or have public insurance, respectively. Hospitals with lower total patient volumes were associated with increased odds of treating medial epicondyle fractures operatively.

The significant variation in treatment of MEF indicates a lack of strong evidence to guide clinical decision-making. This variation suggests that some children may undergo unnecessary procedures, while others may be undertreated, with decisions potentially influenced by non-clinical socioeconomic factors.

(1)Pediatric medial epicondyle fractures (MEF) are common, and treatment approaches vary, with casting and open reduction with internal fixation (ORIF) being the two main strategies.(2)Socioeconomic factors influence the rate of surgical interventions, including insurance coverage and overall healthcare disparities.(3)Hospital factors, such as patient volume, are linked to operation rates, with hospitals having lower total patient volumes associated with higher odds of performing operative treatment.(4)There is a lack of standardization for the preferred treatment approach for pediatric MEF.

Level III.