Related Experiment Video
Updated: Mar 3, 2026
Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
Surgical Versus Nonsurgical Management of Pediatric Medial Epicondyle Fractures: An Updated Systematic Review
Lee R Benaroch1, Ronan J Anderson2, Derek Di Iorio3
1Department of Surgery, Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Insights
Optimal management for pediatric medial epicondyle fractures (MEF) remains debated. Both surgical and non-surgical treatments yield excellent functional outcomes, despite unique risks associated with each approach for pediatric MEF.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Evidence-Based Medicine
Background:
- Consensus on managing pediatric medial epicondyle fractures (MEF) is lacking.
- This systematic review evaluates operative versus nonoperative treatment outcomes for pediatric MEF.
Purpose of the Study:
- To analyze and compare the effectiveness of surgical and non-surgical interventions for pediatric medial epicondyle fractures (MEF).
Main Methods:
- Systematic review adhering to PRISMA guidelines, analyzing studies from January 2019 to August 2025.
- Extracted outcome data and calculated frequency-weighted mean values for common outcomes.
- Included 18 studies with 1372 pediatric patients.
Main Results:
- Nonoperative treatment had higher nonunion rates (29.9%) and stiffness (5.6%). Operative treatment showed ulnar nerve symptoms (6.4%) and stiffness (4.4%), with 13% requiring secondary surgery.
- No significant differences in range of motion (ROM) were found between operative and nonoperative groups in comparative studies.
- Mean Musculoskeletal Outcome Quality Index (MEPS) scores were high for both groups (95.2±6.0 operative, 98.6±0.7 nonoperative).
Conclusions:
- No definitive consensus exists for pediatric medial epicondyle fracture (MEF) management, despite a trend towards surgical intervention.
- Both operative and nonoperative approaches have distinct risks but infrequent complications.
- Excellent functional outcomes, indicated by MEPS and ROM, are achievable with either treatment strategy.
Background:
There remains a lack of consensus regarding optimal management of pediatric medial epicondyle fractures (MEF). This updated systematic review analyzes the outcomes of operative and nonoperative treatment of MEF to determine the effectiveness of each approach.
Methods:
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilized to query studies published between January 2019 and August 2025. All relevant outcome data were extracted. Frequency-weighted mean values with SD for commonly reported outcomes were calculated to demonstrate general trends across studies.
Results:
Eighteen studies with 1372 patients meeting inclusion criteria were included. In total, 1195 patients were treated operatively, with 177 treated nonoperatively. In nonoperative patients, the most common complications were nonunion (N=53, 29.9%) and range of motion loss/stiffness (N=10, 5.6%). The most common complications in surgical patients included ulnar nerve symptoms (N=76, 6.4%) and range of motion loss/stiffness (N=52, 4.4%). Secondary surgery due to complications occurred in 152 operative cases (13%). Four operative studies (N=245) reported ROM (flexion) numerically, resulting in a frequency-weighted average score of 133.2±12.7 degrees. Three operative studies (N=219) reported ROM (extension deficit) numerically, with a frequency-weighted average score of -1.74±5.8 degrees. Five studies directly compared ROM in operative versus nonoperative patients, with 4 finding no significant differences at final follow-up. Six studies (N=357) reported MEPS values for operative patients, resulting in a weighted mean average of 95.2±6.0. Three studies (N=110) reported MEPS values for nonoperative patients, resulting in a weighted mean average of 98.6±0.7.
Conclusions:
There continues to be no consensus on optimal management of isolated MEFs in pediatric patients though a recent trend in the literature towards more operative management. Each approach carries its own unique risks, though complications are infrequent. In general, functional outcomes were excellent in both surgically and nonsurgically managed patients, reflected in MEPS scores and ROM, among other measures.
Level Of Evidence:
Level III-systematic review.
