Open Reduction Internal Fixation of Medial Epicondyle Fractures After Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers

Abstract

Objectives: Ulnar collateral ligament reconstruction (UCLR) is a common procedure among professional baseball pitchers. Currently, 25% of starting Major league baseball (MLB) pitchers have undergone UCLR. Fracture of the medial epicondyle at the level of the humeral tunnel requiring open reduction internal fixation (ORIF) is an uncommon complication following UCLR. The purpose of this study was to determine the rate of return to sport (RTS) and performance upon RTS in professional baseball pitchers following ORIF of the medial epicondyle, and see if there is a difference in RTS rate and performance between players who underwent ORIF and matched controls. The authors hypothesized that there is a high rate of RTS in professional baseball pitchers following medial epicondyle ORIF with no significant difference in rate of RTS or performance, specifically related to the primary outcome performance variables of win-loss percentage (W-L%), WHIP ((walks +hits)/innings pitched), fielding independent pitching (FIP), and wins above replacement (WAR)) between cases and controls. Methods: All professional baseball pitchers who underwent medial epicondyle ORIF between 2010-2016 were included. Demographic and performance data (pre and post surgery) for each player was recorded. Performance metrics were then compared between cases and matched controls (no history of UCLR or ORIF). Results: Overall, 15 pitchers (80% starters, 73.3% right-handed) underwent ORIF of a medial epicondyle fracture. All underwent a prior UCLR using either the American Sports Medicine Institute (n=9, 60%) or docking (n=6, 40%) technique. ORIF techniques included fixation with one screw (n=13, 86.7%) and fixation with suture anchors (n=2, 13.3%). Eleven (73.3%) pitchers were able to RTS (which did not differ from controls p=0.537). No significant differences existed in the primary performance outcome variables when comparing pre-operative to post-operative performance. No significant differences in the primary performance outcome measures were seen between cases and controls following surgery although cases pitched fewer innings than controls following surgery (p=0.003) Conclusion: Following medial epicondyle ORIF of professional pitchers with a history of UCLR, 73.3% were able to RTS without a significant decline in most performance variables when compared to their pre-operative performance levels, or when compared to matched controls. Number of innings pitched declined following surgery.