title: Outcome of nonoperative treatment for humeral medial epicondylar fragmentation before epiphyseal closure in young baseball players.
abstract: BACKGROUND
  Nonoperative treatment for humeral medial epicondylar fragmentation in baseball players, involving prohibition and limitation of throwing, has been reported to give good results. However, in some cases, such nonoperative treatment fails to yield an acceptable outcome.
  
  
  OBJECTIVE
  In nonoperative treatment for patients with medial epicondylar fragmentation, achievement of bone union of the fragmentation provides better clinical outcomes compared with those of patients with delayed bone union or nonunion.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  Fifty-five young baseball players with medial epicondylar fragmentation before epiphyseal closure, aged between 9 and 13 years (mean, 11.0 years), participated in this study. They belonged to baseball teams in a youth league and underwent nonoperative treatment involving prohibition of throwing for an average of 2.0 months and subsequent limitation of throwing for an average of 1.8 months. We investigated whether achievement of bone union of the fragmentation was associated with better clinical outcomes.
  
  
  RESULTS
  Bone union was achieved in 40 (73%) of 55 participants at 6 months after initial presentation, 31 (76%) of 41 participants at 1 year, and 32 (94%) of 34 participants at 2 years. Elbow pain was present in 7 participants (17%) at 1 year after initial presentation and in 6 participants (18%) at 2 years. At 1 year after initial presentation, statistical analysis showed that most participants with elbow pain had significant fragmentation (P = .0055). At 2 years after initial presentation, there was no significant relationship between elbow pain and medial epicondylar fragmentation (P = .32). Statistical analysis also showed that, at both 6 months and 1 year after initial presentation, bone union was significantly delayed in most participants who had not accepted nonoperative treatment and consequently resumed throwing vigorously before bone union.
  
  
  CONCLUSIONS
  At 1 year after initial presentation, bone union of the medial epicondylar fragmentation was correlated with a decreased prevalence of elbow pain. At 6 months and 1 year after initial presentation, delayed bone union of the medial epicondylar fragmentation was associated with resumption of throwing at maximum strength before bone union had occurred.
authors.affiliation: Department of Orthopaedic Surgery, Yamagata University School of Medicine, Iida-Nishi 2-2-2, Yamagata, Japan. miharada@yoshioka-hp.or.jp
authors.forename: Mikio
authors.initials: M
authors.lastname: Harada
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Takahara
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Hirayama
authors.forename: Junya
authors.initials: J
authors.lastname: Sasaki
authors.forename: Nariyuki
authors.initials: N
authors.lastname: Mura
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Ogino
mesh_terms: D000293:Adolescent; D018771:Arthralgia / Q000209:etiology; D001484:Baseball / Q000293:injuries*; D002648:Child; D004551:Elbow Joint / Q000000981:diagnostic imaging; D005500:Follow-Up Studies; D017102:Fracture Healing; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000628:therapy*; D007103:Immobilization; D010349:Patient Compliance; D011859:Radiography; D020127:Recovery of Function