Journal of Pediatric Orthopaedics - 2026-06-08 - Journal Article
Time is of the Essence! Long-Term Functional, Motor and Sensory Outcomes After Surgical Fixation of Pediatric Medial Epicondyle Fractures: A Retrospective Cohort Study.
Akın AE, Erkan S, Okcu G
Topics
Key Takeaway
Delayed surgery for pediatric medial epicondyle fractures correlates strongly with permanent ROM restriction (ρ=-0.631, P=0.002), though overall long-term outcomes are excellent with 100% union and mean QuickDASH of 11.05.
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Summary
This study evaluated long-term functional, sensory, and motor outcomes in 22 pediatric patients who underwent surgical fixation of medial epicondyle fractures, with secondary analysis of dislocation, incarceration, and injury-to-surgery time as outcome modifiers. All patients achieved bony union with no reoperations or infections; mean QuickDASH was 11.05 and sensation and grip strength were preserved relative to the contralateral side. The sole significant deficit was reduced ROM arc on the injured side (135° vs. 140°, P=0.002), with injury-to-surgery time independently correlated with this restriction (ρ=-0.631, P=0.002); neither dislocation nor incarceration significantly affected long-term outcomes.
Key Limitation
The 45% loss to follow-up (22/40 patients) introduces significant selection bias, as patients with worse outcomes may be systematically underrepresented.
Original Abstract
BACKGROUND
Medial epicondyle fractures represent a common pediatric elbow injury, yet a definitive consensus on treatment remains absent. In literature, long-term sensory and motor outcomes after surgical fixation remain underreported. Existing studies predominantly focus on short-term and mid-term results, with limited objective assessment of strength and sensibility.
OBJECTIVES
The primary aim of this study was to evaluate long-term functional, sensory and motor outcomes in patients who underwent surgical fixation for pediatric medial epicondyle fractures. The secondary aim was to examine the impact of associated elbow dislocation, fragment incarceration, and injury-to-surgery time on these long-term outcomes.
METHODS
A retrospective cohort study identified 40 patients aged under 18 who underwent surgical fixation for medial epicondyle fracture between 2000 and 2024. Of these, 22 patients who returned for a clinical control in 2025 and had complete long-term follow-up were included in the study. Demographic data, injury mechanism, injury-to-surgery time, presence of dislocation/incarceration, union, reoperation, infection, and complications were reviewed. Long-term outcomes were assessed at the final control using comparative evaluation against the contralateral side for functional scores (QuickDASH, VAS), range of motion (ROM), varus/valgus stress tests, motor strength (Hand Grip, Lateral Pinch, Palmar Pinch), and sensation (SWMT, S2PD). Nonparametric tests were used for paired (injured vs. uninjured) and subgroup comparisons (sex, dislocation, and incarceration). Spearman correlation was used to analyze the effect of injury-to-surgery time.
RESULTS
Bony union was achieved in all patients, with no instances of reoperation or infection. One patient experienced heterotopic ossification (4.5%). Long-term functional outcomes were excellent (mean QuickDASH: 11.05±17.42; mean
VAS
1.59±2.42). Sensation, motor strength, and stability were preserved compared with the uninjured side. The only significant long-term deficit was a restricted ROM arc on the injured side (median ROM Arc: 135 injured vs. 140 degrees uninjured; P=0.002, large effect). Neither incarceration nor dislocation significantly affected long-term results. However, increased injury-to-surgery time was significantly correlated with decreased ROM for the injured side (ρ=-0.631; P=0.002). No significant effect on increased injury-to-surgery time was observed on pain, functional, or motor outcomes. Worsening sensation (increased S2PD) was significantly associated with decreased grip and pinch strength (ρ = -0.46 to -0.59, P<0.05).
CONCLUSION
Although long-term outcomes following surgical fixation of pediatric medial epicondyle fractures are highly favorable, delayed surgical intervention is significantly associated with permanent ROM restriction. Early, stable fixation combined with personalized, patient-focused rehabilitation can lead to excellent long-term functional results, even in the presence of dislocation or incarceration.