Return to Competitive Sports After Medial Epicondyle Fractures in Adolescent Athletes: Results of Operative and Nonoperative Treatment.

The most effective treatment of medial epicondyle fractures in pediatric athletes is still unclear. A study was conducted to evaluate the outcomes of operative and nonoperative management of medial epicondyle fractures in young athletes. 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. Complete data with 2-year follow-up were available for 20 athletes: 6 treated nonoperatively and 14 treated operatively. The study found that 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 that their performance was limited after treatment, and excellent DASH scores were reached in both groups.

These data show 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 substantial trauma, who have elbow laxity or instability, or who have significant fracture fragment displacement after a fracture of the medial epicondyle.