Postoperative outcomes of pediatric medial epicondyle fractures treated surgically

This study aimed to objectively evaluate the long-term clinical, functional, and sensory outcomes of patients who underwent surgical treatment for medial epicondyle fractures during childhood. The primary objective was to assess long-term patient-reported function (QuickDASH), pain (VAS), range of motion (ROM), clinical stability (varus/valgus stress tests), sensory function (Semmes–Weinstein Monofilament—SWM, static two-point discrimination—S2PD), and muscle performance (grip strength, palmar and lateral pinch). Secondary objectives included evaluating the influence of sex, associated ulnohumeral dislocation or fragment incarceration at the time of injury, implant type, the effect of time from injury to surgery, the relationship between age at surgery and muscle strength, and the effect of postoperative follow-up duration. Comparisons between the injured and uninjured sides were also performed. This single-center, retrospective cross-sectional outcome study included 22 patients who had undergone surgery for medial epicondyle fractures in childhood and were available for follow-up. Standardized protocols were used for all assessments. Outcomes included QuickDASH, VAS, ROM (goniometric flexion-extension arc), sensory tests (S2PD and SWM), and muscle performance (dynamometer grip strength, palmar and lateral pinch meter). Clinical stability was assessed with varus/valgus stress tests. Analyses included Wilcoxon, Mann–Whitney U, Kruskal–Wallis, and McNemar tests, with Spearman correlation applied for continuous variables. All tests were two-tailed with α=0.05; exact p values and effect sizes (r) were reported. Ethics approval and informed consent were obtained, and all data were anonymized. Union was achieved in 100% of cases, with no reoperation or infection. Elbow dislocation was present in 36.4% and fragment incarceration in 22.7% of cases. Implant distribution was: K-wire only 54.5%, screw only 31.8%, combined/other 13.6%. Clinical stability was preserved in nearly all patients, with only one case showing varus/valgus stress positivity. Patient-reported outcomes were favorable: median QuickDASH was 2.27 and median VAS was 0.00. Grip strength, palmar and lateral pinch, and sensory thresholds (SWM and S2PD ~10 mm) did not differ significantly between injured and uninjured sides. However, elbow ROM arc was significantly lower on the injured side (131° vs. 139°). According to clinical thresholds, ROM restriction was present in 18.2% of cases. Subgroup analyses showed no significant effect of sex on QuickDASH, VAS, or ROM; however, female patients had lower grip/pinch strength and higher S2PD values in the injured hand. Neither elbow dislocation nor incarceration significantly affected outcomes. Similarly, no differences were observed among implant types. Correlation analyses revealed that longer injury-to-surgery delay was significantly associated with reduced ROM in both injured and uninjured elbows, but not with QuickDASH or VAS. Unexpectedly, increased delay was associated with a modest improvement in S2PD. Age at surgery was positively correlated with grip and pinch strength, while showing no association with ROM, QuickDASH, VAS, or S2PD. Duration of follow-up after surgery was not significantly related to any outcomes. In conclusion, surgical treatment of pediatric medial epicondyle fractures results in favorable long-term outcomes, with low pain, good function, preserved grip strength and sensory thresholds. The main persistent sequela was reduced ROM in the injured elbow. Delay to surgery was associated with poorer ROM recovery, while implant type and the presence of dislocation or incarceration did not significantly affect long-term outcomes. - Keywords: Medial epicondyle fracture; Pediatric orthopedics; Long-term outcomes; Range of motion (ROM); QuickDASH; Hand function; Ulnar nerve; Elbow instability