Korean J Sports Med.  2023 Mar;41(1):19-26. 10.5763/kjsm.2023.41.1.19.

Operative Treatment of Medial Epicondyle Fractures in Pediatric and Adolescent Patients: Comparative Study of Internal Fixation with Kirschner Wires or Cannulated Screws

• Jung HJ
• Hyun CS
• Lee K
• Park HY

• KMID: 2539686
• DOI: http://doi.org/10.5763/kjsm.2023.41.1.19

Abstract

Purpose
Medial epicondyle fractures are a common elbow injury in pediatric and adolescent patients. The management of these fractures continues to be debated. This study aims to review the long-term clinical and radiological outcomes of operative treatment of medial epicondyle fractures in pediatric and adolescent patients.
Methods
In this study, 24 consecutive patients were categorized into two groups as follows: group 1, 10 patients undergoing internal fixation with Kirschner wires (K-wires) and group 2, 14 patients undergoing internal fixation with cannulated screws. To assess clinical outcomes, Mayo Elbow Performance Score were used in addition visual analogue scale for pain, subjective range of motion, ulnar nerve irritation symptoms, residual instabilities and requirement for secondary surgery were checked. To access the radiological outcomes, check the bone union and possible deformities secondary to the medial epicondyle fractures were examined.
Results
There were no cases of immediate or residual ulnar nerve irritation symptoms and no cases of residual deformity or valgus instability. There was no radiological evidence of loss of reduction and all patients had achieved bone union at last follow-up. And all patients had performed secondary surgery for hardware removal regardless of symptomatic hardware irritation.
Conclusion
Both K-wires fixation for younger children and screw fixation for near skeletal maturity children may provide favorable clinical and radiological outcomes at long-term follow-up, with low morbidity and radiographic deformity. In the K-wire fixation group, it is thought that preoperative explanation is needed because the K-wires tends to be removed earlier than screw fixation group due to hardware irritation.

Keyword

Elbow fractures; Medial epicondyle; Pediatric; Trauma

Figure

• 

  Fig. 1 Flow diagram of the study participants. K-wire: Kirschner wire.

• 

  Fig. 2 A 7-year-old boy with elbow dislocation after a fall from a climbing frame. (A, B) The initial X-ray shows a completely dislocated elbow joint with medial epicondyle avulsion fracture which is incarcerated in the joint. (C, D) Closed reduction brings the medial epicondyle back to its anatomical position; the elbow joint remains stable reduction state. Pre-operative three-dimensional computed tomography (E, F) and magnetic resonance imaging (G, H) shows medial epicondyle fracture. (I, J) Open reduction and internal fixation with Kirschner wires (K-wires) was performed. (K, L) After K-wires removed and the final follow-up radiographs shows a solid bone union.

• 

  Fig. 3 A fourteen-year-old boy with medial epicondyle fracture after arm wrestling. (A, B) The initial X-ray shows a completely displaced medial epicondyle fracture. (C–E) Preoperative three-dimensional computed tomography images show completely displaced medial epicondyle fracture. (F–I) Open reduction and internal fixation with cannulated screw and washer was performed. (J, K) After cannulated screw and washer removed and the final follow-up radiographs show a solid bone union.

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