Long-Term Patient Reported Outcomes of Surgical Versus Nonsurgical Management of Pediatric Medial Epicondyle Fractures

BACKGROUND: Indications for surgical fixation of medial epicondyle fractures have been debated for over 4 decades, with no clear consensus supporting operative versus nonoperative management. Medial epicondyle fractures account for ∼11% to 20% of pediatric elbow fractures and are associated with posterior elbow dislocation in up to 60% of cases. The purpose of this study was to evaluate long-term outcomes of surgical versus nonsurgical management of medial epicondyle fractures with a minimum follow-up of 2 years. METHODS: Pediatric patients evaluated for a medial epicondyle fracture at a tertiary academic health center over a 10-year period were eligible for inclusion. Treatment was determined by the treating surgeon. Operative indications during the study period included fragment incarceration, displacement >5 mm, and elbow valgus instability. Displacement was measured on the internal oblique radiographic view. Eligible patients or their guardians were contacted by telephone and invited to complete standardised patient-reported outcome measures, including the quick disabilities of the Arm, Shoulder, and Hand (QuickDASH) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Upper Extremity Score, to assess functional outcomes 2 to 10 years following treatment. RESULTS: Nonparametric analysis demonstrated significant differences between groups in age at injury (P=0.001), injury occurrence during wrestling (P=0.002), and fracture displacement >5 mm (P<0.001). No significant differences were identified in QuickDASH scores (P=0.649), PROMIS scores (P=0.963), or range of motion between cohorts. CONCLUSIONS: In this unmatched cohort with long-term follow-up, no clinically meaningful differences in patient-reported outcomes were observed between groups. Surgically treated patients were older and had greater fracture displacement, reflecting indication-based treatment selection. These findings suggest that both operative and nonoperative strategies can result in comparable long-term outcomes when applied to appropriately selected patients. LEVEL OF EVIDENCE: Level III.