Background: The treatment of isolated, displaced
fractures of the medial humeral epicondyle in children is controversial.
Both plaster cast immobilization without reduction and open reduction
and internal fixation have been advocated. The purpose of this long-term
retrospective study was to analyze the functional and radiographic
results of both nonsurgical and surgical management of these injuries.
Methods: Forty-two patients who had had
an isolated fracture of the medial humeral epicondyle with displacement
of >5 mm at an average age of twelve years (range, eight
to fifteen years) were evaluated at an average age of forty-five
years (range, thirty to sixty-one years). The patients were divided
into three groups that were comparable with regard to the amount
of fracture displacement, age at the time of the fracture, age at the
time of follow-up, sports activities and occupation, and duration
of follow-up. In Group I (nineteen patients), the fracture
had been treated with a long-arm plaster cast without reduction
of the displaced medial epicondyle. In Group II (seventeen patients),
open reduction and internal fixation with either Kirschner wires
or a T-nail had been performed. In Group III (six patients),
the epicondylar fragment had been excised with suture reattachment
of the tendons and the medial collateral ligament.
Results: According to a functional grading scale,
there were sixteen good and three fair results in Group I. All but
two patients were seen to have nonunion of the fragment on follow-up radiographs,
but all had a normal result on valgus stress-testing of the elbow.
The range of motion of the elbow was either normal or minimally
decreased, and the grip strength of the ipsilateral hand was normal.
There were fifteen good and two fair results in Group II. All patients
had union of the medial epicondyle, with various radiographic deformities
of the medial epicondyle, but the functional results were similar
to those of the Group-I patients. The Group-III patients had four poor
and two fair results. Four had constant pain at the elbow and paresthesias
in the distribution of the ulnar nerve. One patient had a restricted
range of motion of the elbow, four patients had an unstable elbow,
and three patients had decreased grip strength of the ipsilateral
Conclusions: In our study, nonsurgical treatment
of isolated fractures of the medial humeral epicondyle with between
5 and 15 mm of displacement yielded good long-term results
similar to those obtained with open reduction and internal fixation.
The nonunion of the epicondylar fragment that was present in most patients
who had been treated only with a cast did not adversely affect the
functional results. Surgical excision of the medial epicondylar
fragment should be avoided because the long-term results