Medial epicondyle fractures of the distal humerus are common pediatric fractures, which are increasing in frequency among pediatric and adolescent athletes. Residual elbow stiffness is a feared complication of both surgical and non-operative treatment. The purpose of this study is to investigate the association of the relevant variables with the ability of patients to regain full elbow range of motion (FROM). Patients 8-18 years-old enrolled in the Medial Epicondyle Multicenter Outcomes (MEMO) prospective cohort with ≥3 mm of displacement and >1 year of follow-up data were included. Bilateral elbow range of motion (ROM), complications, length of immobilization following definitive treatment (surgical vs. non-operative), participation in formal physical or occupational therapy (PT/OT), and weeks from injury to treatment were recorded. The study cohort consisted of 202 patients (aged 12.7±2.3 years; 59% male). A greater proportion of surgically managed patients regained FROM compared to non-operatively managed patients (71% vs. 56%, P=0.05). Immobilization time was significantly shorter in surgical than non-operative patients (2.0 ±1.1 weeks vs. 3.0±1.2 weeks, P<0.001). In multivariable logistic regression analysis, only immobilization time was an independent predictor of regaining FROM (β=-0.353, P=0.02), which remained statistically significant while controlling for PT/OT (β=0.079, P=0.829) and treatment strategy (β=-0.375, P=0.35). While controlling for treatment strategy and whether a patient received PT/OT, each week of prolonged immobilization decreased the chance of regaining full ROM by 35%. This large multicenter cohort study found that of the variables studied, increased immobilization time was the only independent predictor of residual elbow stiffness following medial epicondyle fractures in children, independent of treatment strategy and receiving PT/OT. With surgical treatment often warranting shorter post-treatment immobilization times, surgery may provide an avenue for consistently regaining FROM when treating these fractures, even in the setting of concomitant dislocation. In cases of minimally displaced fractures, implementing protected early ROM in non-operative cases could be considered. However, when nonoperatively-treated patients in this study were analyzed separately, earlier mobilization was not associated with a protective effect against residual stiffness. Further prospective study into the nuances of surgical indications as well as nonoperative and postoperative immobilization and early motion strategies is therefore warranted.
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