Treatment of medial epicondyle fractures accompanying elbow dislocations in children

Objectives: We evaluated the clinical and radiographic results of treatment for medial epicondyle fractures accompanying elbow dislocations in children. Met hods: The study included 10 children (9 boys, 1 girl; mean age 12 years; range 1.5 to 15 years) with medial epi¬condyle fractures accompanying elbow dislocations. Three patients had posteromedial and seven patients had posterolat¬eral dislocations. Three patients were treated conservatively, while four patients and three patients underwent early and late surgical treatment before or after the seventh day of injury, respectively. Surgery was indicated due to entrapment of the medial epicondyle fragments in three patients, and to insta¬bility in four patients with more than 5 mm of displacement. At surgery, a posteromedial incision was used and ulnar nerve exploration was performed. The results were evaluated using the Mayo elbow performance score. The mean follow-up period was 28 months (range 3 to 103 months). Results: Union of the medial epicondyle fractures was achieved between four to six weeks in all the patients. The mean Mayo elbow performance score was 93.5. Late surgery was associated with a score of 80 in two patients and 75 in one patient, the remaining patients had an excel¬lent result (100 points). Full range of elbow motion was achieved in all the patients treated conservatively and with early surgery; however, following late surgery, two patients had extension and flexion losses of 5° and 10°, respective¬ly. None of the patients had instability postoperatively. Concl u s i o n : Patients with entrapment of the medial epi- condylar fragment in the joint and with a displacement of more than 5 mm should undergo surgery, while those with a displacement of 5 mm or less can be treated conservatively.