Chronic Medial Epicondyle Avulsion: Technique of Fragment Excision and Ligament Reconstruction With Internal Brace Augmentation

Abstract

Medial epicondyle fracture nonunions of the elbow may lead to symptomatic instability in the high-demand or overhead athlete. These injuries are challenging to treat surgically because of the small residual bony fragment, the scarred and shortened chronically injured ulnar collateral ligament (UCL), which prevents it from being mobilized and reduced to its native position. To date, most described methods aim at reducing the displaced fragment and achieving union with the humerus. This usually can only be accomplished by releasing of the scarred UCL to mobilize the fragment. The scarred and attenuated residual ligament is then repaired to restore stability but is often inadequate to sustain high-level valgus loads. We describe a technique of excision of the bony fragment and UCL reconstruction with allograft, augmented with internal brace to provide medial stability to the elbow. The described method allows proper tensioning of the graft and provides immediate and secure fixation.