While a relatively common paediatric elbow injury, there remains a lack of consensus regarding optimal management of paediatric medial epicondyle fractures (MEF). This systematic review analyzes the outcomes of operative and non-operative treatment of MEF to determine the effectiveness of each approach. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilised to query studies published after August 01, 2018. Outcome data, including return to sport/activities, range of motion, secondary surgeries, and Mayo Elbow Performance Score (MEPS) were extracted. Frequency-weighted mean values with standard deviation for other outcomes and total numbers for complications are reported. Seventeen studies with 1331 patients meeting the inclusion criteria were included for data extraction. In total, 1189 patients were treated with open reduction and internal fixation, with 142 treated non-operatively. Five studies provided explicit operative indications, which included medial epicondyle displacement >2–5 mm, any avulsion fracture with visible displacement radiographically, spontaneous dislocation of the elbow under gentle movement, and surgeon preference. In non-operatively managed patients, the most common complications were non-union (N = 29, 20.4%) and range of motion loss/stiffness (N = 10, 7.0%). In the operative group, the most common complications included ulnar nerve symptoms (N = 76, 5.7%) and range of motion loss/stiffness (N = 52, 3.9%). Secondary surgery due to complications (i.e., not routine hardware removal) occurred in 27 operative cases (2.0%). The most common reasons for revision surgery were symptomatic hardware removal (N = 10, 37.0%), ongoing stiffness (N = 5, 18.5%), and ongoing ulnar nerve symptoms (N = 4, 14.8%). The types of reported outcomes varied greatly between the 17 studies, with range of motion (ROM) and the Mayo Elbow Performance Score (MEPS) the most widely reported. Five studies (N = 226) reported post-operative flexion ROM (133.8°±14.7) and four reported extension ROM (−1.6°±6.3). One study found that operative treatment resulted in a shorter median time to full flexion/extension ROM (131 vs. 170 days), however this was not statistically significant. Five studies (N = 255, 21.4% of 1189) reported MEPS values for operative patients, resulting in a weighted mean average of 95.1±7.1, with one additional study reporting that all operative patients (N = 79) achieved excellent outcomes with the MEPS tool (score >90). Two studies (N = 75, 52.8% of 142) reported MEPS values for non-operative patients, resulting in a weighted mean average of 98.9±0.2, with one additional study reporting that all non-operative patients (N = 17) achieved excellent MEPS scores. Although there is no clear consensus regarding operative versus non-operative treatment of MEF in paediatric patients, each approach may come with its benefits and increased risks. Fractures managed non-operatively may be at an increased risk of non-union, whereas those managed operatively carry small risks of reoperation due to hardware complications, elbow stiffness, and ulnar neuropathy. In general, functional outcomes were excellent in both surgically and non-surgically managed patients, reflected in MEPS scores and ROM, among other measures.
Benaroch et al. (Wed,) studied this question.