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. 2020 Oct;40(9):474-480.
doi: 10.1097/BPO.0000000000001601.

Medial Epicondyle Fractures: Biomechanical Evaluation and Clinical Comparison of 3 Fixation Methods Used in Pediatric Patients

Kathleen D Rickert  1   2 , Kara L Sarrel  1   2 , Julia S Sanders  1   2 , Megan E Jeffords  2 , Jessica L Hughes  3 , Vidyadhar V Upasani  1   2 , Christine L Farnsworth  2 , Eric W Edmonds  1   2 , Andrew T Pennock  1   2
Affiliations

Medial Epicondyle Fractures: Biomechanical Evaluation and Clinical Comparison of 3 Fixation Methods Used in Pediatric Patients

Kathleen D Rickert et al. J Pediatr Orthop. 2020 Oct.

Abstract

Background: Screw fixation is the most commonly employed fixation strategy for displaced medial epicondyle fractures, but in younger patients with minimal ossification, the fracture fragment may not accommodate a screw. In these situations, Kirschner-wires (K-wire) or suture anchors may be utilized as alternatives. The purposes of this study were to examine the biomechanical properties of medial epicondyle fractures fixed with a screw, K-wires, or suture anchors, to evaluate clinical outcomes and complications of patients 10 years of age or younger treated with these approaches, and to perform a cost-analysis.

Methods: Biomechanical assessment: Immature pig forelimbs underwent an osteotomy through the medial epicondyle apophysis, simulating a fracture. These were then fixed with a screw, K-wires or suture anchors. Cyclic elongation (mm), displacement (mm), load to failure (N), and stiffness (N/mm) were assessed. Clinical assessment: a retrospective review was performed of patients 10 years of age or younger with a medial epicondyle fracture fixed with these strategies. Radiographic outcomes, postoperative data and complications were compared. These data were used to perform a cost-analysis of each treatment approach.

Results: Biomechanically, screws were stronger (P=0.047) and stiffer (P=0.01) than the other constructs. Clinically, 51 patients met inclusion criteria (screw=27, wires=11, anchor=13). Patients treated with K-wires were younger (P<0.05) and patients treated with screw fixation had a shorter casting duration (P=0.008). Irrespective of treatment strategy, all fractures healed (100%) and only 1 patient in the screw group lost reduction. Clinical outcomes and complications were similar between groups, but the suture anchor group was less likely to require a second surgery for implant removal (P<0.05). This lower reoperation rate led to a cost-saving of 10%.

Conclusions: Biomechanically, all 3 approaches provided initial fixation exceeding the forces observed across the elbow joint with routine motion. The screw construct was the strongest and stiffest. Clinically, all 3 strategies were acceptable, with screw fixation offering a shorter casting duration, but greater implant removal need with higher associated costs.

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References

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