title: Does operative fixation affect outcomes of displaced medial epicondyle fractures?
abstract: OBJECTIVE
  Long-term functional results remain equivocal between operative fixation and closed management of displaced humeral medial epicondyle fractures. The purpose of this study was to determine whether a functional difference exists between treatment types.
  
  
  METHODS
  One hundred and forty patients with a displaced medial epicondyle fracture between 2007 and 2014 met the inclusion criteria. Of this large cohort, only 12 patients agreed to return to clinic at a mean follow-up of 3 years for prospective evaluation. Data collection included radiographs, physical examination, validated outcome tools, and grip strength testing with a Jamar dynamometer.
  
  
  RESULTS
  Both groups were comparable with regard to age, dominant side injured, length of follow-up, preinjury sports involvement, and initial displacement (10 mm operative vs. 9 mm nonoperative); however, half of the surgical group presented with an associated unreduced elbow dislocation versus 0 % in the nonoperative group. Both treatment methods resulted in high patient satisfaction and elbow function scores. There were four osseous nonunions (67 %) and one malunion (17 %) in the nonoperative group versus none in the operative group (p = 0.015). Patients treated nonoperatively had a nonsignificant decrease in grip strength (9 ± 6 lbs) as compared to operative patients (6 ± 5 lbs, medium effect size eta = 0.25, p = 0.25).
  
  
  CONCLUSIONS
  In this small cohort, operative management of displaced medial epicondyle fractures resulted in a higher rate of fracture union and return to sports. Other objective and subjective measures were similar between the two treatment groups.
authors.affiliation: Naval Medical Center Portsmouth, Portsmouth, VA, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Stepanovich
authors.affiliation: Pediatric Orthopedic and Scoliosis Center, Rady Children's Hospital San Diego, 3030 Children's Way, Suite 410, San Diego, CA, 92123, USA.
authors.forename: Tracey P
authors.initials: TP
authors.lastname: Bastrom
authors.affiliation: Pediatric Orthopedic and Scoliosis Center, Rady Children's Hospital San Diego, 3030 Children's Way, Suite 410, San Diego, CA, 92123, USA.
authors.forename: John
authors.initials: J
authors.lastname: Munch
authors.affiliation: Pediatric Orthopedic and Scoliosis Center, Rady Children's Hospital San Diego, 3030 Children's Way, Suite 410, San Diego, CA, 92123, USA.
authors.forename: Joanna H
authors.initials: JH
authors.lastname: Roocroft
authors.affiliation: Pediatric Orthopedic and Scoliosis Center, Rady Children's Hospital San Diego, 3030 Children's Way, Suite 410, San Diego, CA, 92123, USA.|Department of Orthopedic Surgery, University of California, San Diego, San Diego, CA, USA.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Edmonds
authors.affiliation: Pediatric Orthopedic and Scoliosis Center, Rady Children's Hospital San Diego, 3030 Children's Way, Suite 410, San Diego, CA, 92123, USA. apennock@rchsd.org.|Department of Orthopedic Surgery, University of California, San Diego, San Diego, CA, USA. apennock@rchsd.org.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Pennock
keywords: Medial epicondyle fractures; Nonoperative; Operative; Outcomes