Lateral epicondylar fractures in the pediatric population: Presentation, management, and outcomes

Lateral epicondylar fractures in young patients have received limited attention in the literature. This study aims to describe their mechanism of injury, concomitant injuries, management, and long-term outcomes in pediatrics.

This IRB-approved retrospective case series included patients younger than 18 years diagnosed with lateral epicondyle fractures between (2015-2021). Data collected included patient demographics, fracture characteristics at presentation, management details, and clinical outcomes. Patient-reported outcome measures (PROMs) were assessed using the QuickDASH score and associated functional variables.

Twenty-two patients (10 male, 12 female) with a mean age of 10.5 years and BMI of 19.2 were included. Sports-related injuries were the most common mechanism (9 patients, 40.9%), followed by other high-energy falls such as from bicycles, stairs, or hoverboards (13 patients, 59.1%). Sixteen patients (72.7%) had nondisplaced fractures, while six (27.3%) had displaced fractures. Concomitant injuries were present in 12 patients (54.5%), including elbow fracture-dislocations (6, 27.3%), coronoid process fractures (4, 18.2%), and ligamentous injuries (2, 9.1%). Among those with fracture-dislocations, three (50%) also had additional elbow fractures, most commonly involving the medial epicondyle. Three patients (13.6%) required operative intervention-two for symptomatic nonunion and one for lateral collateral ligament reconstruction. All other patients were treated with rigid immobilization in a long arm cast or splint for an average of 4.1 weeks. Post-immobilization stiffness occurred in 36.4% of patients but improved with physical therapy. Sixteen patients (72.7%) had a mean follow-up of 3.2 years. Their average QuickDASH score was 6.0 and the average time to return to activity was 17.4 weeks after injury.

Lateral epicondyle fractures represent a rare but frequently missed fractures, typically resulting from sports activities or high-energy falls that impart axial load and valgus stress to a supinated forearm. Nondisplaced fractures are treated well with long arm immobilization, while displaced fractures and high-energy injuries warrant careful assessment for associated fractures or ligamentous damage, as these may require operative management.