title: Return to competitive sports after medial epicondyle fractures in adolescent athletes: results of operative and nonoperative treatment.
abstract: BACKGROUND
  The optimal treatment of medial epicondyle fractures in pediatric athletes remains unclear.
  
  
  OBJECTIVE
  To evaluate the outcomes of operative and nonoperative management of medial epicondyle fractures in young athletes.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  The records of all children with fractures of the medial epicondyle over a 5-year period, with a minimum 2 years of follow-up at a pediatric tertiary referral center, were reviewed. Patients with intra-articular entrapment of the fracture fragment or ulnar nerve entrapment were excluded. Treatment decisions were made primarily based on injury mechanism and elbow laxity or instability. Patients were contacted and asked to complete a modified Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.
  
  
  RESULTS
  Complete data with 2-year follow-up were available for 20 athletes: 6 treated nonoperatively and 14 treated operatively. At the latest follow-up, both groups achieved excellent DASH scores. Half of each cohort required physical therapy, and 6 of 14 patients who received operative treatment reported numbness. All patients were either very or completely satisfied with their treatment. Fourteen patients were overhead athletes (8 treated operatively, 6 nonoperatively). Excellent DASH scores were achieved in both groups, and all overhead athletes were able to return to their sport at the next appropriate level. Seven patients were baseball pitchers and sustained a fracture while throwing (4 treated operatively, 3 nonoperatively). None felt their performance was limited after treatment, and excellent DASH scores were achieved in both groups.
  
  
  CONCLUSIONS
  These data demonstrate that nonoperative treatment can be successful in young athletes with low-energy medial epicondyle avulsions, a stable elbow, and minimal fracture displacement. Surgical management can be successful in athletes who sustain more significant trauma, who have elbow laxity or instability, or who have significant fracture fragment displacement after a fracture of the medial epicondyle.
authors.affiliation: Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Wood Building, 2nd Floor, Philadelphia, PA 19104-4399, USA. lawrencej@email.chop.edu
authors.forename: J Todd R
authors.initials: JT
authors.lastname: Lawrence
authors.forename: Neeraj M
authors.initials: NM
authors.lastname: Patel
authors.forename: Jonathan
authors.initials: J
authors.lastname: Macknin
authors.forename: John M
authors.initials: JM
authors.lastname: Flynn
authors.forename: Danielle
authors.initials: D
authors.lastname: Cameron
authors.forename: Hayley C
authors.initials: HC
authors.lastname: Wolfgruber
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Ganley
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D054874:Athletic Performance; D002648:Child; D004551:Elbow Joint / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006811:Humerus / Q000293:injuries* / Q000601:surgery; D006987:Hypesthesia / Q000209:etiology; D008297:Male; D026741:Physical Therapy Modalities; D011183:Postoperative Complications / Q000209:etiology; D016059:Range of Motion, Articular; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D000092464:Elbow Injuries
keywords: avulsion; elbow; fracture; medial epicondyle; pediatrics; sports