Does an Associated Elbow Dislocation Lead to Worse Outcomes in Medial Epicondyle Fractures?
Sarah Toner, BS1; Alexandria L Case, BSE2; Joshua M Abzug, MD2
1The Medical University of South Carolina, Charleston, SC, 2University of Maryland School of Medicine, Baltimore, MD
Medial epicondyle fractures account for approximately 1% of fractures in the pediatric population and can be associated with an elbow dislocation in up to 50% of cases. The purpose of this study was to assess differences in outcomes and complications between patients with isolated medial epicondyle fractures and those with a concurrent elbow dislocation in order to better counsel patients and their families, and guide treatment.
A retrospective review was performed at a pediatric academic medical institution over a seven-year period. Patients were identified utilizing CPT and ICD-9/10 codes for medial epicondyle fracture and elbow dislocation. Data obtained included demographics, mechanism of injury, concurrent injuries, treatment modality (immobilization alone vs. operative intervention), post-operative range of motion, and complications. Statistical analysis was performed utilizing Student's t-tests to assess differences between the samples. A power analysis concluded that the use of at least 9 patients with complete data yielded a 90.55% power to detect a 5 degree difference.
Forty-eight patients (22 females, 26 males) with an average age of 10.49 years (range: 4-17) were identified with medial epicondyle fractures over the study period, of which 17 had a concurrent elbow dislocation. The most common mechanisms of injury were falls on outstretched hands (n=22) and falls from heights (n=16). The medial epicondyle fractures with concurrent elbow dislocations more frequently had additional concurrent injuries (8/17 vs 3/31; p=<0.01), which included ulnar nerve injuries (2/17 vs 1/31), anterior interosseous nerve injuries (2/17 vs. 0/31), UCL tears (2/17 vs. 0/31), and other fractures (2/17 vs 2/31). Furthermore, the group with concurrent elbow dislocations was more frequently treated operatively (12/17 vs 8/31; p<0.01). However, final range of motion, as compared to the contralateral side, was not statistically different between the groups (p=0.25). There was no difference in the rate of complications between the groups (3/17 vs 8/31; p=0.57), percentage of therapy referrals (6/17 vs 7/31; p=0.35), or length of follow up (p=0.77).
The outcomes and complications of pediatric and adolescent medial epicondyle fractures with a concurrent elbow dislocation are not clinically or statistically different than those of isolated medial epicondyle fractures. Further investigation into other influencing factors of medial epicondyle fractures that lead to various outcomes and complications is warranted to better guide treatment planning and counseling to these patients and their families.
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