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. 2009 Oct;3(5):345-57.
doi: 10.1007/s11832-009-0192-7. Epub 2009 Aug 15.

Operative versus non-operative management of pediatric medial epicondyle fractures: a systematic review

Atul F Kamath  1 , Keith Baldwin, John Horneff, Harish S Hosalkar
Affiliations

Operative versus non-operative management of pediatric medial epicondyle fractures: a systematic review

Atul F Kamath et al. J Child Orthop. 2009 Oct.

Abstract

Purpose: There is ongoing debate about the management of medial epicondyle fractures in the pediatric population. This systematic review evaluated non-operative versus operative treatment of medial epicondyle fractures in pediatric and adolescent patients over the last six decades.

Methods: A systematic review of the available literature was performed. Frequency-weighted mean union times were used to compare union rates for closed versus open treatments. Moreover, functional outcomes and range-of-motion variables were correlated with varying treatment modalities. Any complications, including ulnar nerve symptoms, pain, instability, infection, and residual deformity, were cataloged.

Results: Fourteen studies, encompassing 498 patients, met the inclusion/exclusion criteria. There were 261 males and 132 female patients; the frequency-weighted average age was 11.93 years. The follow-up range was 6-216 months. Under the cumulative random effects model, the odds of union with operative fixation was 9.33 times the odds of union with non-operative treatment (P < 0.0001). There was no significant difference between operative and non-operative treatments in terms of pain at final follow-up (P = 0.73) or ulnar nerve symptoms (P = 0.412).

Conclusions: Operative treatment affords a significantly higher union rate over the non-operative management of medial epicondyle fractures. There was no difference in pain at final follow-up between operative and non-operative treatments. As surgical indications evolve, and the functional demands of pediatric patients increase, surgical fixation should be strongly considered to achieve stable fixation and bony union.

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Figures

Fig. 1
Fig. 1
DerSimonian and Laird random effects cumulative odds of union with operative treatment versus non-operative treatment. *Did not include fracture excision patients as union of the fracture was not a goal of treatment
Fig. 2
Fig. 2
Year of publication regressed against the number of non-operative patients over the number of studies for each 5-year period. x-axis = year of publication; y-axis = number of patients/number of studies
Fig. 3
Fig. 3
Proposed management algorithm for medial humeral epicondyle fractures
See this image and copyright information in PMC

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