Journal of Pediatric Orthopaedics - 2026-05-08 - Journal Article
Long-Term Patient Reported Outcomes of Surgical Versus Nonsurgical Management of Pediatric Medial Epicondyle Fractures.
Monhollen A, Kolb N, Belzarena AC, Gupta SK
Topics
Key Takeaway
At minimum 2-year follow-up, surgically and nonsurgically treated pediatric medial epicondyle fractures showed no significant difference in QuickDASH (P=0.649) or PROMIS Pediatric Upper Extremity scores (P=0.963).
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Summary
This retrospective cohort study compared long-term patient-reported outcomes of operative versus nonoperative management of pediatric medial epicondyle fractures at a single tertiary center over a 10-year period. Surgical indications included fragment incarceration, displacement >5 mm, and valgus instability; outcomes were assessed via QuickDASH and PROMIS Pediatric Upper Extremity scores. No significant differences in PROs or range of motion were found between groups, though surgical patients were older and had greater displacement, confirming indication-driven treatment allocation.
Key Limitation
Unmatched groups with significant differences in age, fracture displacement, and injury mechanism make it impossible to isolate treatment effect from patient selection, which is the central confound in this debate.
Original Abstract
BACKGROUND
Indications for surgical fixation of medial epicondyle fractures have been debated for over 4 decades, with no clear consensus supporting operative versus nonoperative management. Medial epicondyle fractures account for ∼11% to 20% of pediatric elbow fractures and are associated with posterior elbow dislocation in up to 60% of cases. The purpose of this study was to evaluate long-term outcomes of surgical versus nonsurgical management of medial epicondyle fractures with a minimum follow-up of 2 years.
METHODS
Pediatric patients evaluated for a medial epicondyle fracture at a tertiary academic health center over a 10-year period were eligible for inclusion. Treatment was determined by the treating surgeon. Operative indications during the study period included fragment incarceration, displacement >5 mm, and elbow valgus instability. Displacement was measured on the internal oblique radiographic view. Eligible patients or their guardians were contacted by telephone and invited to complete standardised patient-reported outcome measures, including the quick disabilities of the Arm, Shoulder, and Hand (QuickDASH) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Upper Extremity Score, to assess functional outcomes 2 to 10 years following treatment.
RESULTS
Nonparametric analysis demonstrated significant differences between groups in age at injury (P=0.001), injury occurrence during wrestling (P=0.002), and fracture displacement >5 mm (P<0.001). No significant differences were identified in QuickDASH scores (P=0.649), PROMIS scores (P=0.963), or range of motion between cohorts.
CONCLUSIONS
In this unmatched cohort with long-term follow-up, no clinically meaningful differences in patient-reported outcomes were observed between groups. Surgically treated patients were older and had greater fracture displacement, reflecting indication-based treatment selection. These findings suggest that both operative and nonoperative strategies can result in comparable long-term outcomes when applied to appropriately selected patients.
LEVEL OF EVIDENCE
Level III.