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Medial epicondyle fractures account for up to 20% of all pediatric elbow fractures.1,2 While nonoperative management has been traditionally described as successful, an average of 49% of patients develop a nonunion with conservative treatment. Historical studies lack specific patient reported functional outcome metrics or return to sport data.13,14,16 There is a trend toward operative fixation due to a rising concern for symptomatic valgus instability, stiffness, and long-term functional effects of nonunion in patients treated non-operatively. Operative decision-making focuses on the prevention of chronic valgus instability and desire to return to high-level athletics or future employment.
Nonetheless, surgical treatment is not without risk, including postoperative stiffness, comminution of the medical epicondyle fragment, nerve damage, persistent rotational instability of the fragment, nonunion, and symptomatic hardware.
In order to assist the surgeon considering operative management for a medial epicondyle fracture, we have compiled a series of challenging cases due to delayed presentation or complications, as well as several unique techniques that may be helpful to either prevent or navigate one’s way out of these situations.