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Return to Sport following Medial Epicondyle Avulsion Fracture in the Non-Throwing Upper Extremity Athlete
Nichole M Shaw, MD, MPH
1; John R Fowler, MD
21University of Pittsburgh Medical Center, Pittsburgh, PA; 2Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
Introduction:
Medial epicondyle avulsion fractures represent approximately 10-20% of elbow fractures in skeletally immature individuals. These injuries are classically described in throwing athletes as a result of sudden valgus forces on the medial elbow in an athlete between the ages of medial epicondyle ossification and fusion. Medial epicondyle avulsion fractures exist on the spectrum of medial elbow injuries in athletes ranging from medial epicondyle apophysitis to ulnar collateral ligament (UCL) injuries in skeletally mature athletes, and represent a UCL rupture equivalent in the skeletally immature. Non-throwing upper extremity athletes such as gymnasts and wrestlers commonly experience medial epicondyle fractures, however their return to sport and outcomes have not been delineated clearly.
Materials and Methods:
A retrospective case series was conducted identifying patients sustaining medial epicondyle avulsion fractures within the University of Pittsburgh Medical System between 2010 and 2023. Included patients participated in non-throwing athletics with heavy upper extremity involvement. Patients were excluded for short duration of follow-up, incomplete outcomes measures (range of motion, valgus instability, or return to sport information). Univariate and multivariate analysis was performed to identify differences in outcomes.
Results:
271 patients with medial epicondyle fractures were identified. Of these, 94 non-throwing upper extremity athletes were identified including 45 gymnasts, 11 cheerleaders, 21 wrestlers, 12 non-quarterback football players, 1 hockey, 1 lacrosse, and 3 basketball players. Average age of injury was 11.6 years. 40 patients (42.6%) sustained medial epicondyle avulsions with concomitant elbow dislocations. All-comer return to sport rate was 90.7% (78 of 86 athletes). All athletes able to return to sport had returned by the following season. Football players lost more elbow extension than other groups: average extension deficit 6.7deg vs 1.83deg (p=0.011). Time to return to play, fracture healing, complication rate were similar between groups.
Conclusions:
90 percent of athletes were able to return to their original sport. All athletes able to return to their original sport, returned at the same level of play and returned by the following season. Eight athletes were unable to return to their original sport (one wrestler who returned to pitching, seven gymnasts). Of the eight unable to return, five had the constellation of 5mm displacement, non-dominant arm involvement, and elbow dislocation requiring reduction on presentation. Overall, return to sport is favorable following medial epicondyle avulsion fractures, and providers can counsel patients and family that return to sport at the same level, by the following season, is probable.
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