Journal of Pediatric Orthopaedics - 2026-05-11 - Journal Article
Fragment Incarceration as a Key Determinant of Functional Outcomes After Operative Fixation of Pediatric Medial Epicondyle Fractures: A Single-center Retrospective Cohort Study.
Saritaş TB, Arici V, Yildirim B, Büyükdoğan H, Ertürk C
Topics
Key Takeaway
Fragment incarceration, present in 28% of operatively treated pediatric medial epicondyle fractures, was independently associated with lower MEPS and reduced ROM, while implant type (K-wire vs. cannulated lag screw) produced only a 3–4 point MEPS difference.
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Summary
This single-center retrospective cohort examined functional and radiographic outcomes in 39 patients ≤16 years who underwent ORIF for isolated medial epicondyle fractures (2018–2024), comparing K-wire (n=22) and cannulated lag screw with washer (n=17) fixation. Mean MEPS was 91.9, ROM 133.9°, and radiographic union occurred at mean 5.4 weeks. On multivariable regression, fragment incarceration—not implant type—was the dominant independent predictor of inferior MEPS and ROM.
Key Limitation
The small sample size (n=39, 11 incarcerated cases) at a single center limits generalizability and statistical power, making the multivariable regression estimates unstable.
Original Abstract
BACKGROUND
Medial epicondyle fractures account for a substantial proportion of pediatric elbow injuries, but the determinants of functional outcome after operative fixation remain incompletely defined. This study sought to describe functional and radiographic outcomes after open reduction and internal fixation (ORIF) of pediatric medial epicondyle fractures and to identify clinical, injury-related, and treatment-related parameters associated with these outcomes.
METHODS
We retrospectively reviewed consecutive patients 16 years or younger who underwent ORIF for isolated medial epicondyle fractures between 2018 and 2024, with ≥12 months of follow-up. Fixation was performed with either Kirschner wires (KW) or a cannulated lag screw (LS) with washer. Outcomes at final review included Mayo Elbow Performance Score (MEPS), elbow flexion-extension range of motion (ROM), and forearm rotation range (ROR). Fragment incarceration, preoperative ulnar nerve involvement, complications, and time to radiographic union were recorded. Univariate analyses and multivariable linear regression were used to identify factors associated with MEPS, ROM, and ROR.
RESULTS
Thirty-nine patients were included (KW, n = 22; LS, n = 17; mean age = 12.4 y). The mean time for radiographic union was 5.4 weeks. At final follow-up, mean MEPS was 91.9, ROM 133.9 degrees, and ROR 156.8 degrees. Fragment incarceration occurred in 11 patients (28%), and preoperative ulnar nerve involvement in 4 (10%). In multivariable analysis, fragment incarceration was independently associated with lower MEPS and reduced ROM, whereas KW fixation was associated with a small absolute difference of approximately 3 to 4 MEPS points on the 0 to 100 scale compared with LS. No variable significantly predicted ROR.
CONCLUSIONS
Both K-wire and cannulated lag screw with washer fixation achieved early union and generally excellent function after pediatric medial epicondyle fractures. Within this cohort, fragment incarceration appeared more strongly related to residual functional loss than implant type, supporting individualized implant selection and suggesting that careful attention to reduction, fixation stability, and a protocol-driven early mobilization program may be particularly important when incarceration is present.
LEVEL OF EVIDENCE
Level III, retrospective cohort study.