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Fragment Incarceration as a Key Determinant of Functional Outcomes After Operative Fixation of Pediatric Medial
Tahir Burak Saritaş1, Volkan Arici1, Burak Yildirim2
1Department of Orthopaedics and Traumatology, University of Health Sciences, Kanuni Sultan Süleyman Training and Research.
Insights
Fragment incarceration, not implant type, significantly impacts functional outcomes in pediatric medial epicondyle fractures treated with open reduction and internal fixation (ORIF). Careful reduction and early mobilization are key for optimal results.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Traumatology
Background:
- Medial epicondyle fractures are common in children.
- Factors influencing functional outcomes after surgical fixation are not fully understood.
Purpose of the Study:
- To evaluate functional and radiographic outcomes of open reduction and internal fixation (ORIF) for pediatric medial epicondyle fractures.
- To identify predictors of functional outcomes.
Main Methods:
- Retrospective review of 39 pediatric patients (≤16 years) undergoing ORIF for medial epicondyle fractures.
- Comparison of Kirschner wires (KW) versus cannulated lag screw (LS) fixation.
- Assessment of Mayo Elbow Performance Score (MEPS), range of motion (ROM), and forearm rotation (ROR).
Main Results:
- Fragment incarceration (28%) was linked to lower MEPS and ROM.
- KW fixation showed a minor difference in MEPS compared to LS.
- Early union (mean 5.4 weeks) and good functional scores were generally observed.
Conclusions:
- Both KW and LS fixation provide good outcomes for pediatric medial epicondyle fractures.
- Fragment incarceration is a stronger predictor of functional deficit than implant choice.
- Individualized implant selection and meticulous surgical technique are crucial.
Background:
Medial epicondyle fractures account for a substantial proportion of pediatric elbow injuries, but the determinants of functional outcome after operative fixation remain incompletely defined. This study sought to describe functional and radiographic outcomes after open reduction and internal fixation (ORIF) of pediatric medial epicondyle fractures and to identify clinical, injury-related, and treatment-related parameters associated with these outcomes.
Methods:
We retrospectively reviewed consecutive patients 16 years or younger who underwent ORIF for isolated medial epicondyle fractures between 2018 and 2024, with ≥12 months of follow-up. Fixation was performed with either Kirschner wires (KW) or a cannulated lag screw (LS) with washer. Outcomes at final review included Mayo Elbow Performance Score (MEPS), elbow flexion-extension range of motion (ROM), and forearm rotation range (ROR). Fragment incarceration, preoperative ulnar nerve involvement, complications, and time to radiographic union were recorded. Univariate analyses and multivariable linear regression were used to identify factors associated with MEPS, ROM, and ROR.
Results:
Thirty-nine patients were included (KW, n = 22; LS, n = 17; mean age = 12.4 y). The mean time for radiographic union was 5.4 weeks. At final follow-up, mean MEPS was 91.9, ROM 133.9 degrees, and ROR 156.8 degrees. Fragment incarceration occurred in 11 patients (28%), and preoperative ulnar nerve involvement in 4 (10%). In multivariable analysis, fragment incarceration was independently associated with lower MEPS and reduced ROM, whereas KW fixation was associated with a small absolute difference of approximately 3 to 4 MEPS points on the 0 to 100 scale compared with LS. No variable significantly predicted ROR.
Conclusions:
Both K-wire and cannulated lag screw with washer fixation achieved early union and generally excellent function after pediatric medial epicondyle fractures. Within this cohort, fragment incarceration appeared more strongly related to residual functional loss than implant type, supporting individualized implant selection and suggesting that careful attention to reduction, fixation stability, and a protocol-driven early mobilization program may be particularly important when incarceration is present.
Level Of Evidence:
Level III, retrospective cohort study.
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