Mid-term Clinical and Radiological Results of Surgically Treated Pediatric Medial Humeral Epicondyle Fractures: Screw or K Wire?
PDF
Cite
Share
Request
Research
P: 415-420
December 2018

Mid-term Clinical and Radiological Results of Surgically Treated Pediatric Medial Humeral Epicondyle Fractures: Screw or K Wire?

Med J Bakirkoy 2018;14(4):415-420
1. Marmara Üniversitesi Pendik Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Kliniği, İstanbul, Türkiye
2. Sarıkamış Devlet Hastanesi, Ortopedi ve Travmatoloji Kliniği, Kars, Türkiye
No information available.
No information available
Received Date: 27.01.2018
Accepted Date: 09.05.2018
Publish Date: 28.12.2018
PDF
Cite
Share
Request

ABSTRACT

Objective:

The aim of the present study was to evaluate the clinical and radiological results of surgically treated pediatric medial humeral epicondyle fractures which were fixed with screw or K wire.

Materials and Methods:

The study was designed retrospectively. Twenty two patients were evaluated clinically and radiologically. Functional outcomes were assessed with the Mayo elbow performance index (MEPI) and the Turkish language version of the shortened version of the Disabilities of Arm, Shoulder, and Hand (Quick DASH) scale.

Results:

All fractures were healed. The mean MEPI was 99.3 points (range, 85-100), with 21 patients as excellent and 1 good results. The mean MEPI was 100 points for patient who was fixed with K wires (group A). Excellent results were obtained for all patients. The mean MEPI was 97.9 points (range, 85-100) for patients with screw fixation (group B). Excellent results were obtained for all patients, except one. The mean Quick DASH score was 0.63 (range, 0-9). It was found 0.33 (range 0-5) and 1.3 (range, 0-9) for group A and group B, respectively. Two (13%) minor complications were developed in group A and 4 (57.3%) in group B. The difference for Quick DASH and MEPI scores were statistically insignificant (p>0.05).

Conclusion:

Both of fixations with K wire or screw provide enough stability until the fracture healed. Fracture union could be obtained for both fixation type and the clinical and radiological results were similar. The need for secondary operation for implant removal and higher complication rates seems the negative side of screw fixation.

Keywords:
Medial epicondyle fracture, surgery, screw, K wire

References

1
Michael P. Glotzbecker and James R. Kasser.  “The elbow: physeal fractures, apophyseal injuries of the distal humerus, osteonecrosis of the trochlea, and t-condylar fractures.” Rockwood and Wilkins’ fractures in children 8th ed (2015): 725-750.
2
Gottschalk HP, Eisner E, Hosalkar HS. Medial epicondyle fractures in the pediatric population. J Am Acad Orthop Surg 2012;20:223-32.
3
Pathy R, Dodwell ER. Medial epicondyle fractures in children. Curr Opin Pediatr 2015;27:58-66.
4
Wilkins KE: Fractures involving the medial epicondylar apophysis, in Rockwood CA Jr, Wilkins KE, King RE, eds: Fractures in Children, ed 3. Philadelphia, PA, JB Lippincott, 1991, pp 509-828.
5
Knapik DM, Fausett CL, Gilmore A, Liu RW. Outcomes of Nonoperative Pediatric Medial Humeral Epicondyle Fractures With and Without Associated Elbow Dislocation. J Pediatr Orthop 2017;37:e224-e8.
6
Beck JJ, Bowen RE, Silva M. What’s New in Pediatric Medial Epicondyle Fractures? J Pediatr Orthop 2018;38:e202-e6.
7
Stepanovich M, Bastrom TP, Munch J 3rd, Roocroft JH, Edmonds EW, Pennock AT.  Does operative fixation affect outcomes of displaced medial epicondyle fractures? J Child Orthop 2016;10:413-9.
8
Mehlman CT, Howard AW. Medial epicondyle fractures in children: clinical decision making in the face of uncertainty. J Pediatr Orthop 2012;32 Suppl 2:S135-42.
9
Case SL, Hennrikus WL. Surgical treatment of displaced medial epicondyle fractures in adolescent athletes. Am J Sports Med 1997;25:682-6.
10
Farsetti P, Potenza V, Caterini R, Ippolito E. Long-term results of treatment of fractures of the medial humeral epicondyle in children. J Bone Joint Surg Am  2001;83-A:1299-305.
11
Hines RF, Herndon WA, Evans JP. Operative treatment of medial epicondyle fractures in children. Clin Orthop Relat Res 1987;223:170–4.
12
Josefsson PO, Danielsson LG. Epicondylar elbow fracture in children. 35-year follow-up of 56 unreduced cases. Acta Orthop Scand 1986;57.313-5.
13
Lee HH, Shen HC, Chang JH, Lee CH, Wu SS. Operative treatment of displaced medial epicondyle fractures in children and adolescents. J Shoulder Elbow Surg 2005;14:178-85.
14
Papavasiliou VA. Fracture-separation of the medial epicondylar epiphysis of the elbow joint. Clin Orthop Relat Res 1982:172-4.
15
Patel NM, Ganley TJ. Medial epicondyle fractures of the humerus: how to evaluate and when to operate. J Pediatr Orthop 2012;32(suppl 1):S10–S3.
16
Smith FM. Medial epicondyle injuries. JAMA 1950;142:396-402.
17
Oksüz C, Akel BS, Leblebicioğlu G, Kayıhan H. Which hand outcome measurement is best for Turkish speaking patients? Acta Orthop Traumatol Turc 2012;46:83-8.
18
Mayo Elbow Performance Score. J Orthop Trauma 2006;20:S127.
19
Edmonds EW, Santago AC, Saul KR. Functional Loss With Displacement of Medial Epicondyle Humerus Fractures: A Computer Simulation Study. J Pediatr Orthop 2015;35:666-71.
20
Louahem DM, Bourelle S, Buscayret F, Mazeau P, Kelly P, Dimeglio A, et al. Displaced medial epicondyle fractures of the humerus: surgical treatment and results. A report of 139 cases. Arch Orthop Trauma Surg 2010;130:649-55.
21
Gottschalk HP, Bastrom TP, Edmonds EW. Reliability of internal oblique elbow  radiographs for measuring displacement of medial epicondyle humerus fractures: a  cadaveric study. J Pediatr Orthop 2013;33:26-31.
22
Edmonds EW. How displaced are “nondisplaced” fractures of the medial humeral  epicondyle in children? Results of a three-dimensional computed tomography analysis. J Bone Joint Surg Am 2010;92:2785-91.
23
Souder CD, Farnsworth CL, McNeil NP, Bomar JD, Edmonds EW. The Distal Humerus Axial View: Assessment of Displacement in Medial Epicondyle Fractures. J Pediatr  Orthop 2015;35:449-54.
24
Canavese F, Marengo L, Tiris A, Mansour M, Rousset M, Samba A, et al. Radiological, clinical and functional evaluation using the Quick Disabilities of the Arm, Shoulder and Hand questionnaire of children with medial  epicondyle fractures treated surgically. Int Orthop 2017;41:1447-52.
25
Pace GI, Hennrikus WL. Fixation of Displaced Medial Epicondyle Fractures in Adolescents. J Pediatr Orthop 2017;37:e80-e82.
26
Park KB, Kwak YH. Treatment of medial epicondyle fracture without associated elbow dislocation in older children and adolescents. Yonsei Med J 2012;53:1190-6.
27
Wilson NI, Ingram R, Rymaszewski L, Miller JH. Treatment of fractures of the medial epicondyle of the humerus. Injury 1988;19:342-4.
28
Pimpalnerkar AL, Balasubramaniam G, Young SK, Read L. Type four fracture of the medial epicondyle: A true indication for surgical intervention. Injury 1998;29:751-6.
29
Marcu DM, Balts J, McCarthy JJ, Kozin SH, Noonan KJ. Iatrogenic radial nerve  injury with cannulated fixation of medial epicondyle fractures in the pediatric humerus: a report of 2 cases. J Pediatr Orthop 2011;31:e13-6.