Medial Epicondyle Fractures Treated with Diverse Fixation Techniques: A Case Series

Introduction: Medial epicondyle fractures of the humerus, account for ~12–20% of pediatric elbow fractures and are often associated with elbow dislocations. Management is debated, especially for moderately displaced injuries. Conventionally, displaced fractures were sometimes treated non-operatively, yielding acceptable function but high rates of fibrous non-union. Recent evidence shows surgical fixation provides ~9-fold higher union rates without significant differences in long-term pain or nerve function. We present five patients treated with different fixation techniques to highlight management considerations and outcomes. Case Series: Five patients (ages 15–70; 4 male, 1 female) with acute medial epicondyle fractures (presentation within 2 weeks post trauma) underwent open reduction and internal fixation using varied methods: (1) percutaneous Kirschner-wires (K-wires), (2) a single cannulated cancellous (CC) screw, (3) an antiglide plate, (4) combined K-wire plus screw, and (5) a CC screw. Surgery was performed for displacement >5 mm or instability, in line with current recommendations. Post-operative immobilization ranged 2–4 weeks (shorter for screw fixation, longer for K-wires), followed by physiotherapy. At final follow-up (12–36 months), all fractures united (mean ~12 weeks), and patients resumed full activities. Elbow range of motion was near-normal (flexion ≥130°; one transient 5° extension lag resolved after hardware removal). No growth arrests or chronic instability occurred. Functional outcomes were excellent: Mayo Elbow performance scores 90–100 (mean ~96), and quick disabilities of the arm, shoulder, and hand scores (QuickDASH) indicated minimal disability. No non-union, deep infections, or redislocation were seen, consistent with published results. Conclusion: Medial epicondyle fractures can be effectively treated with various fixation strategies tailored to fragment size, age, and injury pattern. Rigid fixation (screws, plate) enables early mobilization and reliable union, while K-wires remain useful for smaller apophyseal fragments. All methods in this series restored elbow stability and excellent function. Fixation choice should balance fragment anatomy and potential complications: screws enhance purchase but often require removal, whereas K-wires spare the growth center but necessitate longer immobilization. This series emphasizes that diverse fixation approaches – from K-wires to plating – can achieve excellent outcomes when applied judiciously. Surgical fixation in displaced or unstable cases promotes union and allows early return to activity.