Operative Fixation of Medial Humeral Epicondyle Fracture Nonunion in Children

Abstract

There is little information regarding the clinical presentation and/or surgical treatment of symptomatic medial humeral epicondyle nonunions. The purpose of this investigation was to describe the presenting symptoms and evaluate the results of surgical fixation of medial epicondyle nonunions. Eight patients with symptomatic medial humeral epicondyle nonunions were evaluated after open reduction and internal fixation of the medial epicondyle. Average age at the time of initial injury was 11.3 years (range: 9.2 to 13.9 y). Outcome was assessed with radiographs and a questionnaire that included 3 self-reported functional outcome tools at a mean of 4.7 years (range: 1.5 to 7.5 y) after the surgery. Common presenting symptoms and signs included medial elbow pain and prominence, pain with lifting weights or throwing, limited range of motion, valgus instability, and ulnar nerve compression. After open reduction and internal fixation, patients reported improved pain score from a mean of 6.2 to 0.5. All patients returned to athletics. Mean postoperative QuickDASH (Disability of Arm, Shoulder, and Hand) score (and SD) was 6.8 ± 11.7; mean Mayo Elbow Performance Score was 85.8 ± 14.6; and mean Timmerman-Andrews Elbow Score was 87.5 ± 10.4. Radiographic union was achieved in all but one patient postoperatively and there were no operative complications. Open reduction and internal fixation of symptomatic medial humeral epicondyle nonunion results in improved pain and good elbow function. Retrospective Case Series. Therapeutic Level IV.