Postoperative QuickDASH Scores Research Articles

Prospective Evaluation of Opioid Consumption Following Cubital Tunnel Decompression Surgery.

Managing postoperative pain is important for patients and surgeons. However, there is concern over opioid dependency. Cubital tunnel decompression is among the most common upper extremity surgeries. Our study aimed to analyze opioid use after cubital tunnel decompression to guide postoperative opioid prescribing. We prospectively collected opioid consumption for 16 consecutive months (February 2016 to June 2017) for cubital tunnel decompression patients. Data on demographics, insurance type, surgery performed, functional questionnaires (Quick Disabilities of the Arm, Shoulder and Hand [QuickDASH]), and electrodiagnostics (electromyography) were collected. Opioid consumption was reported at first postoperative visits. One hundred patients consumed a mean of 50 morphine equivalent units (MEUs) (range, 0-300), or 7 oxycodone 5-mg pills, postoperatively. Cubital tunnel release (CuTR) patients consumed fewer than ulnar nerve transposition (UNT) patients (40.4 vs 62.5 MEUs or 5.4 vs 8.3 pills, P = .08). Patients undergoing submuscular UNT consumed more than CuTR (115.0 vs 40.4 MEUs or 15.3 vs 5.4 pills, p = 0.003) and more than subcutaneous UNT patients (37.8 MEU or 5.0 pills, p = 0.03). Medicare patients consumed less than privately insured (42.7 vs 54.1 MEUs, 5.7 vs 7.2 pills, P = .02) and less than workers' compensation patients (76.8 MEU or 10.2 pills, P = .04). Older patients consumed fewer than younger patients ( P = .03). Postoperative QuickDASH score was positively related to opioid intake ( P = .009). Patients consumed 7 oxycodone 5-mg pills after cubital tunnel decompression. Younger, privately insured, and workers' compensation patients, and those with worse functional scores and those undergoing UNT (specifically the submuscular technique) consumed more opioids.

Functional outcome following open carpal tunnel release

Introduction: Carpal tunnel syndrome is the most commonly reported upper limb neuropathy, and occurs due to median nerve entrapment in the carpal tunnel of the wrist. Open carpal tunnel release is the most accepted treatment modality and offers good results. The present study was conducted with the aim to determine the functional outcome following open carpal tunnel release. Materials and methods: This is an institutional based prospective interventional study conducted at Dr RML Institute of Medical Sciences, Lucknow. 100 patients with Carpal Tunnel syndrome, fulfilling the inclusion criteria, were treated with open carpal tunnel release. Diagnosis of carpal tunnel syndrome was based upon clinical features and physical examination. Preoperative radiographs, nerve conduction velocity and relevant blood investigations were performed. Patients were followed up postoperatively at 6 weeks, 3 months and 6 months. Relevant statistical analysis of the data was done. Results: The study had 100 subjects with the mean age of 42.82 ± 14.68 years. 52% in our group were females and 48% males. Bilateral hand involved was seen in 82% of cases and 18% were unilateral. Dominant hand involvement was seen in 36% of cases, non dominant involvement in 40% of cases and both hand equally involved in 24% of cases. 32% of patients had associated hypothyroidism and 22% had associated Rheumatoid arthritis. Preoperative and 6 months postoperative Quick-Dash scores revealed significant improvement. Conclusion: Outcomes following open Carpal Tunnel release are very encouraging in terms of functional results as well as patient satisfaction. Quick dash score can be considered as a reliable and valuable tool for evaluating the outcome following surgery in the upper extremity. All the subjects showed a considerable improvement in the score after our procedure.

Validity of QuickDASH at day of surgery versus day of initial consultation: Does informed consent make a difference?

The trend toward requiring explicit consent from patients participating in observational research increases time and resources required to perform such research. Informed consent introduces the potential for "consent bias"-either through selection bias or through the "Hawthorne effect," where patients may alter responses based upon the awareness of participation in a study, thus potentially limiting its applicability to a generalized orthopedic practice. We hypothesized that administering Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) to patients on the day of surgery with informed consent would alter responses in a statistically and clinically meaningful way compared to patients who complete QuickDASH as a quality control measure. We previously instituted the QuickDASH questionnaire as the standard new patient intake and postoperative questionnaire for quality assurance purposes. We retrospectively reviewed data on a cohort of patients who underwent isolated carpal tunnel release (CTR) who had completed preoperative and postoperative QuickDASH forms without providing consent for study participation. Next, a cohort of patients scheduled to undergo isolated CTR who completed the intake questionnaire was approached on the day of surgery for consent to participate in the study. After obtaining consent but prior to surgery, these patients completed a second questionnaire and then completed a postoperative questionnaire on follow-up at a mean of 8 weeks postoperatively. Thirty-nine patients and 35 patients were included in the retrospective and prospective cohorts, respectively. No significant differences were observed in age, gender, symptom duration, nerve conduction study/electromyography results, or disease severity between the two groups. We identified no statistically significant difference in preoperative or postoperative QuickDASH score between the retrospective and prospective cohorts (39.8 ± 22.7 vs. 39.7 ± 19.1 preoperatively; 27.3 ± 24.7 vs. 18.7 ± 13.3 postoperatively) or within the prospective cohort before and after obtaining informed consent. Informed consent did not significantly alter patient responses to the QuickDASH questionnaire. These results suggest that both "opt-in" and "opt-out" approaches to observational research in hand surgery provide results that may be applicable to a generalized orthopedic practice. This study provides evidence that will inform the interpretation of observational research findings in hand surgery.

Functional outcome of open surgical A1 pulley release in diabetic and nondiabetic patients.

Trigger finger, also referred to as stenotic flexor tenosynovitis, is a common condition affecting the digits, with a lifetime incidence of 2.6% among the healthy population and up to 16.5% in diabetic patients. Diabetes mellitus is associated with multiple musculoskeletal conditions including trigger finger. In this study, we aimed to compare the functional outcome of trigger finger release in diabetic and nondiabetic patients to evaluate whether the management of trigger finger in diabetic patients should be the same as that in nondiabetic patients, or whether diabetic patients would benefit from a more tailored management plan to optimize results. A retrospective case-control study was performed at a single center among patients who underwent A1 pulley release from January 2013 to February 2017. Patients were diagnosed with trigger finger grades I to IV according to the Quinnell classification and assessed using the The Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire (Arabic version). Sixty-nine patients, including 21 male (30.4%) and 48 female (69.6%), underwent A1 pulley release surgery. More than half of the participants included in this study were diabetic (n = 40, 58%) and 29 were nondiabetic (42%). The mean postoperative QuickDASH scores were 19.93 among diabetic patients and 17.15 among nondiabetic patients. There was no significant difference in the functional outcome between diabetic and nondiabetic ( p = 0.6) patients. The postoperative functional outcomes are similar in diabetic and nondiabetic patients. Therefore, the management of trigger finger should be the same in both groups.

Impact of smoking and preoperative electrophysiology on outcome after open carpal tunnel release

Background: The aim was to evaluate the influence of smoking and preoperative electrophysiology on the outcome of open carpal tunnel release.Methods: This retrospective observational study evaluated the outcome in 493 patients (531 hands) primary operated for carpal tunnel syndrome. Data were collected from medical records, health evaluations, and QuickDASH questionnaires before surgery and 1 year after.Results: Smokers had a higher QuickDASH score preoperatively as well as postoperatively, but the change in total score did not differ. The odds of having a postoperative QuickDASH score >10 were 2.5 times higher in smoking patients than in non-smoking patients. In 124/493 patients (25%), no clinically significant improvement was seen. Normal and extreme preoperative electrophysiology values were associated with higher postoperative scores. No correlation was found between preoperative QuickDASH scores and preoperative electrophysiology values.Conclusions: Smokers with carpal tunnel syndrome experience more symptoms preoperatively. Smokers have remaining symptoms after surgery. There is no correlation between preoperative QuickDASH scores and preoperative electrophysiology values. Patients with normal or near to normal preoperative electrophysiology results have limited improvement after surgery.

The Oblique Metaphyseal Shortening Osteotomy of the Distal Ulna: Surgical Technique and Results of Ten Patients.

Background Ulnocarpal abutment is a common condition following distal radius fractures. There are different surgical methods of treatment for this pathology: open and arthroscopic wafer procedure or an ulnar shortening osteotomy. We describe an oblique metaphyseal shortening osteotomy of the distal ulna using two cannulated headless compression screws. We report the results of 10 patients treated with this method. Materials and Methods Out of 17 patients, 10 could be reviewed retrospectively for this study. Patient-rated outcomes were measured using the VAS (visual analogue scale) for pain, PRWHE (patient-rated wrist and hand evaluation) survey, and Quick-DASH (disability of arm, shoulder and hand) survey for functional outcomes. At the review we measured the range of motion (ROM) of the wrist (extension and flexion, ulnar and radial deviation, pronation and supination). Grip strength, pronation, and supination strength of the forearm was measured using a calibrated hydraulic dynamometer. ROM and strength of the affected wrist was compared with ROM and strength of the unaffected wrist. Surgical Procedure Oblique long metaphyseal osteotomy of the distal ulna (from proximal-ulnar to distal-radial), fixed with two cannulated headless compression screws. Results The average postoperative VAS score for pain was 23.71 (standard deviation [SD] of 30.41). The average postoperative PRWHE score was 32.55 (SD of 26.28). The average postoperative Quick-DASH score was 28.65 (SD of 27.21). The majority of patients had a comparable ROM and strength between the operated side and the non-operated side. Conclusion This surgical technique has the advantage of reducing the amount of hardware and to decrease the potential hinder caused by it on medium term. Moreover, the incision remains smaller, and the anatomic metaphyseal localization of the osteotomy potentially allows a better and rapid healing.

Distal biceps reconstruction using an Achilles tendon allograft, transosseous EndoButton, and Pulvertaft weave with tendon wrap technique for retracted, irreparable distal biceps ruptures

Distal biceps ruptures can result in ongoing pain and weakness when treated nonoperatively. If retraction of the tendon renders primary repair impossible, reconstruction using a graft is recommended. The current literature includes a variety of techniques with studies reporting small patient numbers. The aim of this study was to report the results of a larger cohort of patients using a technique modified from those previously described in the literature. Twenty-one consecutive male patients underwent distal biceps reconstruction through 2 small anterior incisions using an Achilles tendon allograft that was fixed distally using a transosseous EndoButton and secured proximally using a Pulvertaft weave and tendon wrap. The mean age was 44 years, and the mean time to surgery was 25 months (range, 2-96 months). Functional outcomes were collected prospectively. The mean preoperative Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score (11 patients) was 1.9 (range, 0-4.5). The mean postoperative Oxford Elbow Score, QuickDASH score, and Mayo Elbow Performance Score were 44.7 (range, 35-48), 4 (range, 0-20.5), and 92.9 (range, 70-100), respectively, at a mean follow up of 15 months (range, 6-35 months). The mean postoperative QuickDASH score was significantly improved compared with preoperatively (P < .001). All patients were satisfied and all returned to their previous level of activity. There were 2 transient lateral antebrachial cutaneous nerve paresthesias, and 2 patients had a 5° extension lag. There were no other complications. Achilles allograft reconstruction of retracted irreparable distal biceps ruptures provides consistently good results with few complications using this technique.

Interpretation of the QuickDASH score after open carpal tunnel decompression: threshold values associated with patient satisfaction.

We studied the correlation between change in the QuickDASH score and the absolute post-operative QuickDASH score with patient satisfaction after open carpal tunnel decompression. Threshold values in the QuickDASH score, the point at which the sensitivity and specificity are maximal in predicting patient satisfaction, were identified. During the study period, outcome data were compiled for 937 carpal tunnel decompressions, which included 219 (23%) male and 718 (77%) female patients with a mean age of 58 years (standard deviation (SD) 14). There was a significant improvement (mean difference 32, 95% confidence interval (CI) 30 to 34) in the QuickDASH from a mean of 54 (SD 20) to 22 (SD 23) at 1 year after surgery. There were 808 (86%) patients who defined their outcome as satisfactory at 1 year. The identified threshold values for the post-operative QuickDASH score (⩽34 points) and the change (⩾20 points) in the score were highly predictive of patient satisfaction. However, these threshold values varied significantly according to the baseline pre-operative score. The threshold values identified in the QuickDASH can be used to interpret the score. However, the influence of the pre-operative baseline score should be taken into account when comparing different cohorts of patients or using the values to power future studies. Prognosis, observational cohort study.

Scaphoid Excision and Four-Corner Fusion for Neglected Perilunate Dislocations: Preliminary Results.

Perilunate dislocations are severe uncommon carpal injuries. They are sometimes missed with a reported incidence of up to 25%. Neglect for a period of time allows for soft tissue contractures, as well as bony changes that make reduction extremely difficult. For neglected cases, procedures such as staged open reduction, proximal row carpectomy, and wrist arthrodesis have been offered. The objective of this study was to examine whether scaphoid excision and four-corner fusion could be used to treat neglected perilunate dislocations. Ten patients with neglected perilunate dislocations were managed by scaphoid excision and four-corner fusion. The dominant hand was involved in eight cases. Graft material for the fusion was obtained from the excised scaphoid. Six patients had complete relief of pain both at rest and during stressful activities. Two patients had no pain at rest and mild pain on stressful activities. The remaining two patients had mild pain at rest and moderate pain on stressful activities. The arc of extension/flexion of the wrist and grip strength both improved as compared to their preoperative levels. The average postoperative Quick DASH score was 12.5. Scaphoid excision with four corner fusion could be used to treat neglected perilunate dislocations with good pain relief and good hand function.

Usefulness of QuickDASH in patients with cervical laminoplasty

PurposeClumsiness and numbness of the upper extremity is one of the most common complaints of patients with cervical myelopathy. However, most previous evaluations after cervical laminoplasty have only been based on physicians’ points of view. We used Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) self-report questionnaire, which was designed to measure physical function and symptoms in people with upper-limb disorders to evaluate functional outcomes after laminoplasty. MethodsNinety-four patients who underwent laminoplasty for cervical myelopathy and replied to the questionnaire were included in this study. The average age was 62 years, and mean follow-up period was 61 months. The Japanese Orthopedic Association (JOA) score, Neck Disability Index (NDI), Short-Form Health Questionnaire of 36 questions (physical component score, PCS), upper-extremity pain (Numerical Rating Scale), and QuickDASH (0-100, 0 being least severe) were used to evaluate surgical outcomes. Satisfaction with treatment was also investigated, and internal consistency and criterion-related validity were evaluated. The QuickDASH cutoff value for patient satisfaction was determined by receiver operating characteristic curve (ROC) analysis. ResultsThe mean total JOA scores were 10 before and 13 after surgery, and average postoperative QuickDASH score was 30. Cronbach a of the QuickDASH was 0.94. QuickDASH was significantly correlated with JOA score for upper-extremity motor and sensation, NDI, PCS, and pain. Cutoff value of the QuickDASH was 34.0 by ROC analysis. Significantly better QuickDASH scores were found for patients who were satisfied with treatment than for those who were not, whereas JOA score for upper-extremity motor function did not show a significant difference. DiscussionQuickDASH had significant correlations with disease-specific JOA scores and other generic outcome measures. Moreover, QuickDASH significantly reflected patients’ satisfaction with treatment, whereas the JOA score for upper-extremity motor function did not. ConclusionQuickDASH was useful in evaluating upper-extremity functional outcomes after cervical laminoplasty.

Arthroscopic Partial Trapeziectomy with Soft Tissue Interposition for Symptomatic Trapeziometacarpal Arthritis (SS-50)

Arthroscopic Partial Trapeziectomy with Soft Tissue Interposition for Symptomatic Trapeziometacarpal Arthritis (SS-50)

The Effect of Informed Consent on Results of a Standard Upper Extremity Intake Questionnaire

The trend toward requiring explicit consent from patients participating in observational research introduces the potential for consent bias, either through selection bias or through the Hawthorne effect. In the Hawthorne effect, patients may alter responses based on awareness of participation in a study, thus potentially limiting its applicability to a generalized orthopedic practice. We hypothesized that study subjects' awareness of participation in an observational study by informed consent would alter responses to a standard upper extremity questionnaire in a statistically and clinically meaningful way compared with patients who filled out the questionnaire as a quality control measure. We retrospectively reviewed data on 39 patients who underwent isolated carpal tunnel release, who had completed preoperative and postoperative Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) forms without providing consent for study participation. Next, we approached 35 patients scheduled to undergo isolated carpal tunnel release who completed the intake questionnaire on the day of surgery, for consent to participate in the study. After obtaining consent but before surgery, these patients completed a second questionnaire and then completed a postoperative questionnaire at a mean of 8 weeks postoperatively. There were no significant differences in age, sex, insurance status, symptom duration, nerve conduction study and electromyography results, or disease severity between groups. We identified no statistically significant difference in preoperative or postoperative Quick DASH score between the retrospective and prospective cohorts (40 ± 23 vs 40 ± 19 preoperatively; 27 ± 25 vs 19 ± 13 postoperatively) or within the prospective cohort before and after obtaining informed consent. Informed consent did not significantly alter patients' responses to the Quick DASH questionnaire. These results suggest that both opt-in and opt-out approaches to observational research in hand surgery provide results that may be applicable to a generalized orthopedic practice. This study provides evidence that will inform the interpretation of observational research findings in hand surgery.

Comparison of short- to medium-term results of Coonrad-Morrey elbow replacement in patients with rheumatoid arthritis versus patients after elbow injuries

BackgroundThe aim of this study was to assess the utility of the Coonrad-Morrey elbow prosthesis in patients with severe elbow dysfunction secondary to rheumatoid arthritis (RA) or post-traumatic elbow dysfunction.Material/MethodsThe study involved 35 patients followed up for a mean of 36 months. The patients were divided into those with RA (Group I) and those with post-traumatic elbow dysfunction (Group II). Treatment outcomes were evaluated according to the Mayo Elbow Performance Score (MEPS) and the Disabilities of the Arm, Shoulder and Hand Score (Quick DASH).ResultsAccording to the MEPS, there were 20 (57.15%) excellent, 12 (34.3%) good, 1 (2.85%) fair, and 2 (5.7%) poor outcomes. The mean post-operative Quick-DASH score for the entire study group was 37.73 points. In subgroup analysis, the MEPS-based evaluation revealed: 14 (70%) excellent, 5 (25%) good, and 1 (5%) satisfactory outcome in Group I, versus 6 (40%) excellent, 7 (46.7%) good, and 2 (13.3%) poor outcomes in Group II. The mean Quick Dash scores were 78.64 points in Group I and 76.36 points in Group II. The final MEPS scores in Group I (p=0.000018) and Group II (p=0.00065) were most markedly influenced by reduction in elbow pain and improvement in the ability to perform activities of daily living (ADL): p=0.000018 in Group I and p=0.000713 in Group II.ConclusionsThe treatment outcomes confirm the utility of arthroplasty for severe elbow dysfunctions; they were most strongly influenced by pain reduction and improved ability to perform activities of daily living.

Reconstruction of the radial collateral ligament of the metacarpophalangeal joints of the fingers

Injury to the collateral ligament of the metacarpophalangeal (MP) joint is less common in the finger than the thumb and can have a significant impact on function. When it affects the middle finger, we have observed a more extensive mechanical disturbance than that affecting just the MP joint, and for the central two fingers with less accessible ligaments, we have developed a strong method of reconstruction using a tendon graft which also corrects the mechanical disturbance caused by loss of suspension of the assemblage nucleus which holds the flexor tendons and adjacent structures into the convexity of the transverse palmar arch. Ten patients with painful chronic radial collateral ligament injuries of the MP joint of the finger were treated surgically. Eight of these patients received reconstruction using a tendon graft, whilst in one case, the ligament was reattached directly using a suture and in one by a tendon transfer. All patients achieved a good outcome following their surgery. Of the six patients treated with the described tendon graft technique, the average post-operative QuickDASH score was 0; the average post-operative grip strength, as a percentage of the unaffected good side, was 100 %, and the average active flexion, active extension, and passive extension were 83°, −8° and −24°, respectively. For the middle and ring fingers, we recommend reconstruction using a tendon graft in order to restore the support to the whole flexor mechanism in the palm and to overcome the difficulty presented by inaccessibility of the ligament. Our cases treated in this way have shown full recovery of the function and correction of incipient deformity even when subluxation had started to occur. Level of Evidence: Level V, therapeutic study.

Effectiveness of Four-Corner Arthrodesis with Use of a Locked Dorsal Circular Plate

Compared with traditional methods of fixation in four-corner arthrodesis, reviews of results using a dorsal circular plate (DCP) have identified higher complication rates. As the use of circular plate fixation for limited wrist arthrodesis was found to be a valuable concept per se and continued innovation and technical advancement are crucial to improve future treatment, changes in plate design were encouraged. To further evaluate the use of DCP fixation in four-corner arthrodesis, we report the first results using a radiolucent, nonmetallic (polyetheretherketone), locked DCP for four-corner arthrodesis. We retrospectively analyzed the clinical and radiographic results of 24 patients who underwent four-corner arthrodesis with a locked DCP at a minimum followup of 63months (mean, 76months; range, 63-91months). There were nine women and 15 men, with a mean age of 53years (range, 37-78years) at the time of surgery. We evaluated ROM with a goniometer and grip strength with a dynamometer. Function was assessed using QuickDASH. Radiographs were evaluated for union, carpal alignment, and hardware problems. At latest followup, ROM averaged 66% and 77% of the uninjured side in flexion-extension and radioulnar deviation, respectively. Grip strength averaged 70% of the uninjured side. The average postoperative QuickDASH score was 19.11. Union was achieved by 22 of the 24 patients. Our data show four-corner arthrodesis with a radiolucent, nonmetallic, locked DCP is an effective procedure that allows stable primary fixation as a basis for good functional outcome, provided surgical technique and quality of bone graft are adequate. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Erfahrungen mit der SRTM-PIP-Prothese als Gelenkersatz: Eine retrospektive Studie mit einer Follow-up Periode von 2,4 Jahren

In the following article we present our results with a cemented titanium/polyethylene prosthesis. The SR (TM)-PIP-prosthesis from the firm SBI (©) (formally Avanta (©)) was implanted in 39 patients in our clinic from 2001-2007. In all, we were able to follow-up in a retrospect clinical study 32 patients with 39 proximal interphalangeal joint prostheses. We examined the range of motion, the strength and looked for deformities. The patients had to fill in a questionnaire before examination about their pain and limitation in daily life. We also performed X-rays of the operated fingers. The postoperative range of motion was about 67°. The strength mean value was 24.7 kg. 4 patients needed surgical revisions, in one case due to loosening of the proximal part of the prosthesis. 2 patients also received a tenoarthrolysis because of extension deficits and one patient because of a swan-neck deformity. We noted 7 swan-neck deformities and in 7 cases we found implant loosening of the proximal part of the prothesis. The postoperative Quick-DASH score was about 32.2 and showed a good result. All participants reported a marked improvement in pain reduction. These positive results, the reduction of pain and the satisfaction of the patients advocate the use of this prosthesis for the proximal interphalangeal joint. The postoperative ROM is comparable to those of other prostheses. Concerning implant loosening and swan-neck deformity, these results still offer room for improvement. Critical judgement and further development of the prosthesis design, the operation technique and the instrumentation are required to further optimise the results.

The QuickDASH Score: A Patient-reported Outcome Measure for Dupuytren’s Surgery

Study Design Retrospective Cohort. Introduction There is currently no validated patient reported outcome measure (PROM) for Dupuytren's disease. We have performed a retrospective analysis of QuickDASH scores taken before and after surgery for Dupuytren's disease to assess the validity and responsiveness of the QuickDASH and evaluate its suitability to being a PROM for this condition. Purpose of the Study To determine the eligibility of the QuickDASH score as a Patient Reported Outcome Measure for Dupuytren's disease. Methods Patients were identified from the hand therapy database that had surgery performed between January 2006 and April 2008 who had documented pre- and post-operative QuickDASH scores. Results 69 patients were identified with complete datasets with a mean change in QuickDASH score of −7.14 (p < 0.001) and an improvement of extension deficit by 68.1 degrees (p < 0.001) at a mean 110 day follow-up. The change in QuickDASH score did not correlate with the change in extension deficit. The effect size was 0.545 and the standardised response mean was 0.580. Conclusion The QuickDASH is an acceptable PROM for Dupuytren's surgery with limitations. Further research is needed examining PROMs with this common condition. Level of Evidence n/a.

Operative Fixation of Medial Humeral Epicondyle Fracture Nonunion in Children

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.