Abstract
In the pediatric population, medial humeral epicondylar fractures account for nearly 12% of all elbow fractures. There is ongoing debate about the surgical management of medial epicondyle fracture cases. Our technique in the operative management of medial epicondyle fractures uses the external application of an Esmarch bandage, as well as provisional fixation with needle rather than K-wire fixation. This technique decreases the need for soft-tissue release and, therefore, theoretically, maintains soft-tissue vascularity of the small fracture fragments. Moreover, it preserves the soft-tissue tension medially. It involves the use of a bandage that is universally available in orthopedic operating rooms, including those in developing nations. It is easy to apply by either the principal or assisting surgeon. With practice, it cuts down operative time and can help substitute for an assistant. This relatively simple operative technique makes for a more seamless operative process, improved reduction, and key preservation of soft-tissue vascularity.
Highlights
Medial humeral epicondylar fractures account for nearly 12% of all elbow fractures, with a notable proportion associated with elbow dislocations [1, 2]
Other indications for operative fixation of medial epicondyle fractures have changed over the years
It remains an athletic injury, and, the demand for complete recovery and full function remains high in most referral centers that commonly treat these injuries
Summary
Medial humeral epicondylar fractures account for nearly 12% of all elbow fractures, with a notable proportion associated with elbow dislocations [1, 2]. The common origin of wrist flexors and medial collateral ligament attachments exert traction forces on the medial epicondyle [3, 4]. Acute fractures involve either a direct force applied to the medial epicondyle or an avulsion force from valgus or extension loading; dislocation plays an important mechanical role in affecting this fracture pattern [6, 7]. While not the focus of this technique paper, chronic injuries involve valgus overuse, including repetitive pitching and throwing activities such as those seen in ‘‘Little Leaguer’s elbow’’ [8]
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