Novel fixation of medial epicondyle fractures in a throwing athlete using suture bridge technique.

Abstract

Abstract Background In a throwing athlete, appropriate treatment of a medial epicondyle fracture is important to prevent valgus instability of the elbow. However, there is no consensus for optimal fixation technique for medial epicondyle fractures in a throwing athlete. Non-union, bony fragmentation, and osteonecrosis are potential complications which can have huge implications on an athlete’s sporting career. We propose a new technique that avoids use of metal implants to restore anatomy and potentially the need for subsequent surgery (e.g., to remove screw fixation). Methods A case of a 14-year-old baseball pitcher with medial epicondyle fracture of elbow is presented that was fixed using a suture bridge technique using four 3.5 mm polyetheretherketone (PEEK) SwiveLocks™ loaded with 2 mm wide FiberTape™ and #2 FiberWire™. The sutures were secured in a crossing fashion through the flexor pronator mass to reduce the fracture and offer strong fixation without metal implants. Results Radiological evidence of complete healing was observed in desired position at 12 weeks of follow-up and the patient was cleared for full baseball activity at 7 months after the surgery. Conclusion The suture bridge technique for fixation of medial epicondyle fractures resulted in complete bone healing with excellent patient satisfaction. This technique adapts principles from other sports medicine surgeries to achieve strong fixation without need for subsequent removal of implants. Due to the importance of the UCL for the throwing athlete, this technique may be useful to help avoid injury to the UCL attachment site. Additionally, this technique may help preserve medial epicondyle bone, protect the bony vascular supply, and prevent medial epicondyle fragmentation.