Medial Epicondyle Fractures Treated with Diverse Fixation Techniques: A Case Series

Medial epicondyle fractures of the humerus, account for ~12-20% of pediatric elbow fractures and are often associated with elbow dislocations. Management is debated, especially for moderately displaced injuries. Conventionally, displaced fractures were sometimes treated non-operatively, yielding acceptable function but high rates of fibrous non-union. Recent evidence shows surgical fixation provides ~9-fold higher union rates without significant differences in long-term pain or nerve function. We present five patients treated with different fixation techniques to highlight management considerations and outcomes.

Five patients (ages 15-70; 4 male, 1 female) with acute medial epicondyle fractures (presentation within 2 weeks post trauma) underwent open reduction and internal fixation using varied methods: (1) percutaneous Kirschner-wires (K-wires), (2) a single cannulated cancellous (CC) screw, (3) an antiglide plate, (4) combined K-wire plus screw, and (5) a CC screw. Surgery was performed for displacement >5 mm or instability, in line with current recommendations.Post-operative immobilization ranged 2-4 weeks (shorter for screw fixation, longer for K-wires), followed by physiotherapy. At final follow-up (12-36 months), all fractures united (mean ~12 weeks), and patients resumed full activities. Elbow range of motion was near-normal (flexion ≥130°; one transient 5° extension lag resolved after hardware removal). No growth arrests or chronic instability occurred. Functional outcomes were excellent: Mayo Elbow performance scores 90-100 (mean ~96), and quick disabilities of the arm, shoulder, and hand scores (QuickDASH) indicated minimal disability. No non-union, deep infections, or redislocation were seen, consistent with published results.

Medial epicondyle fractures can be effectively treated with various fixation strategies tailored to fragment size, age, and injury pattern. Rigid fixation (screws, plate) enables early mobilization and reliable union, while K-wires remain useful for smaller apophyseal fragments. All methods in this series restored elbow stability and excellent function. Fixation choice should balance fragment anatomy and potential complications: screws enhance purchase but often require removal, whereas K-wires spare the growth center but necessitate longer immobilization. This series emphasizes that diverse fixation approaches - from K-wires to plating - can achieve excellent outcomes when applied judiciously. Surgical fixation in displaced or unstable cases promotes union and allows early return to activity.