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Medial Elbow Ulnar Collateral Ligament Reconstruction With and Without Medial Epicondyle Fractures in Children
Ryan A Hoffman, MD1, Scott H Kozin, MD2 and Dan A Zlotolow, MD2, (1)Einstein Healthcare Network, Philadelphia, PA, (2)Shriners Hospital for Children Philadelphia, Philadelphia, PA

INTRODUCTION:
There is a paucity of literature on ulnar collateral ligament (UCL) reconstruction with or without medial epicondyle (ME) fracture nonunions in children. Our study investigated if UCL reconstruction with or without ME fragment excision can improve pain, range of motion (ROM), instability, or return to play in pediatric populations.

METHODS:
This was a retrospective case series approved by the institutional review board. All operative records of two Orthopedic surgeons were filtered for Current Procedural Terminology code 24346 (reconstruction of medial collateral ligament, elbow, with tendon graft). This search yielded five patients, all included in this study. Of these, three underwent additional ME excision for nonunion. Patient outcomes included pre/post-operative ROM, elbow stability, and pain. Additionally, patient participation in competitive sports and ability to return to previous level of participation was documented.

RESULTS:
All five patients underwent UCL reconstruction, with three undergoing additional ME fragment excision for chronic nonunion. Preoperative complaints included medial elbow pain, gross instability, ulnar nerve dysfunction, and loss of motion. Average pre-operative range of motion was 10°extension (range 0-20) to 134°flexion (range 95-150). All patients demonstrated full pronation and supination. Of the four patients actively involved in competitive sports, all reported compromised performance, with three discontinuing participation. The average interval between injury and ligament reconstruction was 42.6 months. Final ROM improved to 0-150°in all patients. No patients reported worsening pain, ulnar nerve symptoms, or instability post-operatively. All patients involved in competitive sports were able to return to pre-injury level of participation.

DISCUSSION/CONCLUSION:
UCL reconstruction with or without ME excision is a viable option to improve pain, instability, and ROM for pediatric patients presenting with symptomatic ME nonunion and/or UCL insufficiency. Our findings also suggest that ME excision with UCL reconstruction may be a salvage option in patients presenting 9 months after injury.


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