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Long-Term Patient Reported Outcomes of Surgical Versus Nonsurgical Management of Pediatric Medial Epicondyle
Andrew Monhollen1, Nash Kolb, Ana C Belzarena
1Department of Orthopaedic Surgery, University of Missouri, Columbia, MO.
Insights
Surgical versus nonoperative management of pediatric medial epicondyle fractures yields similar long-term outcomes. Both approaches are effective when appropriately selected, despite differences in patient age and fracture displacement.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Trauma surgery
Background:
- Medial epicondyle fractures are common pediatric elbow injuries, often associated with dislocations.
- Surgical fixation indications remain debated, lacking consensus on operative vs. nonoperative management.
- This study evaluates long-term functional outcomes of both treatment strategies.
Purpose of the Study:
- To compare long-term outcomes of surgical versus nonsurgical management for pediatric medial epicondyle fractures.
- To assess functional recovery and patient-reported outcomes after treatment.
Main Methods:
- Retrospective review of pediatric patients with medial epicondyle fractures over 10 years.
- Treatment decisions (operative/nonoperative) based on surgeon criteria (e.g., displacement >5mm, instability).
- Long-term follow-up (2-10 years) using standardized patient-reported outcome measures (QuickDASH, PROMIS).
Main Results:
- No significant differences in QuickDASH or PROMIS scores between surgical and nonoperative groups.
- Significant differences noted in age at injury, wrestling as cause, and initial fracture displacement.
- Comparable range of motion observed between treatment cohorts.
Conclusions:
- Long-term patient-reported outcomes are similar for surgically and non-surgically treated medial epicondyle fractures.
- Treatment selection based on fracture characteristics and instability is key.
- Both operative and nonoperative strategies can achieve comparable results in appropriately selected pediatric patients.
Background:
Indications for surgical fixation of medial epicondyle fractures have been debated for over 4 decades, with no clear consensus supporting operative versus nonoperative management. Medial epicondyle fractures account for ∼11% to 20% of pediatric elbow fractures and are associated with posterior elbow dislocation in up to 60% of cases. The purpose of this study was to evaluate long-term outcomes of surgical versus nonsurgical management of medial epicondyle fractures with a minimum follow-up of 2 years.
Methods:
Pediatric patients evaluated for a medial epicondyle fracture at a tertiary academic health center over a 10-year period were eligible for inclusion. Treatment was determined by the treating surgeon. Operative indications during the study period included fragment incarceration, displacement >5 mm, and elbow valgus instability. Displacement was measured on the internal oblique radiographic view. Eligible patients or their guardians were contacted by telephone and invited to complete standardised patient-reported outcome measures, including the quick disabilities of the Arm, Shoulder, and Hand (QuickDASH) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Upper Extremity Score, to assess functional outcomes 2 to 10 years following treatment.
Results:
Nonparametric analysis demonstrated significant differences between groups in age at injury ( P =0.001), injury occurrence during wrestling ( P =0.002), and fracture displacement >5 mm ( P <0.001). No significant differences were identified in QuickDASH scores ( P =0.649), PROMIS scores ( P =0.963), or range of motion between cohorts.
Conclusions:
In this unmatched cohort with long-term follow-up, no clinically meaningful differences in patient-reported outcomes were observed between groups. Surgically treated patients were older and had greater fracture displacement, reflecting indication-based treatment selection. These findings suggest that both operative and nonoperative strategies can result in comparable long-term outcomes when applied to appropriately selected patients.
Level Of Evidence:
Level III.
