Surgical Outcome of Pediatric Medial Humeral Epicondylar Fracture with a Displacement of More Than 2 Millimeters

Recent evidence supports the superiority of surgery over conservative treatment in the management of medial humeral epicondylar fractures (MHEF) with the displacement of more than 2 mm, regardless of other indications for surgical intervention. Objectives: We evaluate this strategy in a cohort of pediatric MHEF with more than 2mmdisplacement. Methods: A total of 10 pediatric patients with MHEF and more than 2 mm displacement were included in the study. Relative and absolute indications for surgical intervention were present in five and one patient, respectively. No surgical indication was present in the other four cases. Elbow dislocation had occurred in three cases. All the patients were treated with open reduction and internal fixation (ORIF). The outcome measures included: Radiographic unio‎n, elbow range of motion, and Mayo elbow performance score (MEPS). Results: At the final follow-up session, the mean flexion was 129°6.1°. Flexion contracture and hyperextension were seen in three (30%) and one (10%) patient, respectively. The mean supination and pronation were 81°3.2° and 80.5°1.6°, respectively. MEPS was 100 (excellent) in nine patients and 55 (poor) in one patient. Radiographic unio‎n was observed in all the patients. In one patient, ulnar nerve neurolysis was performed 23 months after the initial surgery due to severe tenderness around the medial epicondyle. Conclusions: ORIF management of MHEF is an easy procedure with a low complication rate and satisfactory outcomes. Thus, we suggest the surgical approach for all pediatric patients with MHEF and displacement of > 2 mm, regardless of the presence of other indications for surgery.