After the plaster immobilization was removed, the elbow joint improved until a satisfactory range of motion was obtained. In each case, the number of wires used was dictated by the size of the detached bone fragment, which ranged from 11 × 6 to 20 × 10 mm, measured intraoperatively. The joint was immobilized for three weeks in the case of a fracture with dislocation, and five weeks in the case of an isolated fracture. The fragments of the bones were assessed intraoperatively by fluoroscopy. In patients with elbow dislocation, a closed reduction was first performed, followed by an open epicondyle repositioning with Kirschner wire stabilization. We used two or three Kirschner wires followed by plaster cast immobilization. The fractures were internally fixed after dissecting of the tissue and identification of the ulnar nerve with 40°–60° flexion in the elbow joint with concomitant pronation of the forearm. The surgical procedure was performed with tourniquet from medial surgical approach (ORIF). The aim of the study was to analyse the outcomes of ORIF treatment for medial epicondyle fractures using Kirschner wires, and to compare the results between patients with and without elbow dislocation.Īll patients were treated surgically. This is a widely available and cheap surgical approach to fixed bone fractures that does not require high technical skills. K- wires stabilization is the procedure performed in our centres. However, the decision to choose surgical or conservative treatment, as well as the method of fixation, remains controversial 4, 6, 9, 14. The fragments are typically joined using sutures, Kirschner wires or pulling screws, as well as bioabsorbable screws or anchors. In surgical treatment, access is achieved from a medial incision with an ulnar port visualization. Indications for surgical fixation for paediatric medial epicondyle fractures include: open fracture, concurrent elbow dislocation, fragment incarceration, fracture displacement > 5 mm, and fractures in upper extremity athletes 4, 6, 9, 14. Treatment of medial epicondyle fracture can be operative or conservative. X-ray images can be used to determine the degree and direction of the fracture displacement (according to the Watson-Jones classification), as well as the degree of displacement and the nature of the fracture (according to the Wilkins classification) 7, 13. Diagnosis is based primarily on physical examination combined with radiological examination in the AP and lateral projection. The medial epicondyle is the site of the attachment of various muscles, including the radial and ulnar flexor of the wrist, the superficial flexor of the fingers, the palmaris longus and the pronator teres muscle.Īlthough injury can occur directly, leading to multi-fragment fractures, but it is more commonly indirect such cases often result in elbow deformation, leading to an avulsion fracture of the medial epicondyle or a sudden hyperextension causing dislocation of the elbow 12.
In 30–60% of cases, fracture is associated with elbow dislocation 5, 6, 7, 8, 9, 10, 11. In the paediatric population, medial epicondyle fractures account for 11–20% of all humerus fractures, with most occurring between the ages of 11 and 12 1, 2, 3, 4, and being four times as common among boys than girls. Similar outcomes are observed between patients with and without dislocation according to MEPS however, flexion and extension are more limited in the former group. ORIF with K wires is a safe procedure for treating medial epicondyle humeral fractures that yields good or very good results. Medial elbow instability was found in seven patients: two with elbow dislocation and five without. Ulnar nerve function was normal in 110 patients: in the other two, it resolved spontaneously in one, and the nerve was transposed in the other. One patient required revision surgery due to nonunion. The dislocation group demonstrated significantly greater extension and flexion deficits (p = 0.019, p < 0.001, respectively). Those with an isolated medial epicondyle fracture demonstrated a mean flexion of 140.7° and extension deficit of 3.0°, while those with an elbow dislocation displayed a mean flexion of 134.5° and extension deficit 6.1°. Out of 112 patients tested, 98 achieved an excellent treatment result, ten good and a mean Mayo Elbow Performance Score (MEPS) no significant differences were observed between dislocated and non-dislocated elbow groups. Of these, 81presented with an isolated medial epicondyle fracture (mean age 11.6 years), and 31 with an elbow dislocation (mean age 11.9 years). The study included 112 patients operated on in 2005–2016. The present study analyses the outcome of open reduction and internal fixation (ORIF) of humerus medial epicondyle fracture with the use of Kirschner (K) wires, and determine the effect of elbow dislocation.
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