An MRI-based comparative study of pediatric medial epicondyle fractures with and without concomitant elbow dislocation

To investigate and compare the Magnetic Resonance Imaging (MRI) characteristics of pediatric medial humeral epicondyle fractures (MHEFs) with and without concomitant elbow dislocation, delineating the extent and complexity of associated injuries to inform clinical management and prognostic assessment. Preoperative MRI data from 58 pediatric patients undergoing surgery were retrospectively analyzed. Patients were classified into a dislocation group ( n = 26) and a non-dislocation group ( n = 32). Differences in age, sex, and side of injury were compared using independent t-tests and χ² tests, as appropriate. MRI findings of the medial collateral ligament (MCL), radial collateral ligament (RCL), common flexor tendon (CFT), common extensor tendon (CET), and ulnar nerve were systematically evaluated. Descriptive statistics (percentages and absolute numbers) are emphasized, with p-values reported for exploratory comparisons. The mean age of the dislocation group was 10.0 ± 3.1 years and 11.5 ± 3.1 years of the non-dislocation group ( P > 0.05). The incidence of MCL complete tear in the dislocation group (61.5%, 16/26) was significantly higher than in the non-dislocation group (9.4%, 3/32). RCL and CET injury were observed exclusively in the dislocation group (16 cases), with no such injury in the non-dislocation group. CFT injury were relatively common in both groups, occurring in 22 cases in the dislocation group and 30 cases in the non-dislocation group, with no significant difference. The incidence of ulnar nerve injury was higher in the dislocation group (11.5%, 3/26) compared to the non-dislocation group (3.1%, 1/32), but the difference was not statistically significant. In this cohort of surgically treated pediatric MHEFs, MRI demonstrates distinct soft tissue injury patterns between patients with and without elbow dislocation–specifically, a higher frequency of complete MCL tears and lateral-sided injuries in the dislocation group, which can potentially inform treatment planning. However, further research correlating these MRI patterns with clinical outcomes is needed before recommending MRI as a routine guide for management.