title: Valgus Instability of the Elbow Due to Medial Epicondyle Nonunion: Treatment by Fragment Excision and Medial Collateral Ligament Reconstruction.
abstract: BACKGROUND
  The medial epicondyle nonunion becomes symptomatic valgus instability with medial elbow pain and joint instability due to dysfunction of the medial collateral ligament (MCL), thus requiring surgical treatment. The purpose of the present study is to report the clinical result of the fragment excision and ligament reconstruction by free tendon graft in the treatment of symptomatic medial epicondyle nonunion.
  
  
  METHODS
  A retrospective study of five consecutive patients was performed. All five patients had signs and symptoms of valgus instability of the elbow. The mean period of nonunion was 25 years, and their injuries progressed asymptomatically until symptoms developed in adulthood after a second injury.
  
  
  RESULTS
  All patients were treated by fragment excision and MCL reconstruction. At the final follow-up, no patients exhibited pain or instability. The mean joint range of motion was 0o of extension and 138o of flexion, with an MEPS of 100 points in all patients.
  
  
  CONCLUSIONS
  By ligament reconstruction for MCL insufficiency and removing the bone fragments avoided irritation by the bone fragments, pain and instability disappeared, good range of motion was restored, and excellent outcomes were achieved in all patients. We believe that fragment excision and MCL reconstruction should be considered as the treatment option for symptomatic medial epicondyle nonunion of the humerus.
authors.affiliation: 1 Hand and Microsurgery Center, Seikeikai Hospital, Osaka, Japan.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Kaneshiro
authors.affiliation: 1 Hand and Microsurgery Center, Seikeikai Hospital, Osaka, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Hidaka
authors.affiliation: 1 Hand and Microsurgery Center, Seikeikai Hospital, Osaka, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Yano
authors.affiliation: 1 Hand and Microsurgery Center, Seikeikai Hospital, Osaka, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Fukuda
authors.affiliation: 1 Hand and Microsurgery Center, Seikeikai Hospital, Osaka, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Sakanaka
mesh_terms: D000293:Adolescent; D000328:Adult; D017885:Collateral Ligaments / Q000293:injuries / Q000601:surgery*; D004550:Elbow; D004551:Elbow Joint / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D005599:Fractures, Ununited / Q000150:complications*; D006801:Humans; D006810:Humeral Fractures / Q000150:complications*; D007593:Joint Instability / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D016059:Range of Motion, Articular / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013710:Tendons / Q000637:transplantation; D055815:Young Adult; D000092464:Elbow Injuries
keywords: Ligament reconstruction; Medial collateral ligament of the elbow; Medial epicondyle nonunion