title: Operative versus non-operative management of pediatric medial epicondyle fractures: a systematic review.
abstract: OBJECTIVE
  There is ongoing debate about the management of medial epicondyle fractures in the pediatric population. This systematic review evaluated non-operative versus operative treatment of medial epicondyle fractures in pediatric and adolescent patients over the last six decades.
  
  
  METHODS
  A systematic review of the available literature was performed. Frequency-weighted mean union times were used to compare union rates for closed versus open treatments. Moreover, functional outcomes and range-of-motion variables were correlated with varying treatment modalities. Any complications, including ulnar nerve symptoms, pain, instability, infection, and residual deformity, were cataloged.
  
  
  RESULTS
  Fourteen studies, encompassing 498 patients, met the inclusion/exclusion criteria. There were 261 males and 132 female patients; the frequency-weighted average age was 11.93 years. The follow-up range was 6-216 months. Under the cumulative random effects model, the odds of union with operative fixation was 9.33 times the odds of union with non-operative treatment (P < 0.0001). There was no significant difference between operative and non-operative treatments in terms of pain at final follow-up (P = 0.73) or ulnar nerve symptoms (P = 0.412).
  
  
  CONCLUSIONS
  Operative treatment affords a significantly higher union rate over the non-operative management of medial epicondyle fractures. There was no difference in pain at final follow-up between operative and non-operative treatments. As surgical indications evolve, and the functional demands of pediatric patients increase, surgical fixation should be strongly considered to achieve stable fixation and bony union.
authors.affiliation: Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 2nd Floor, Silverstein Building, Philadelphia, PA, 19104, USA.
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authors.lastname: Baldwin
authors.forename: John
authors.initials: J
authors.lastname: Horneff
authors.forename: Harish S
authors.initials: HS
authors.lastname: Hosalkar
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