Background: There remains a lack of consensus regarding optimal management of pediatric medial epicondyle fractures (MEF). This updated systematic review analyzes the outcomes of operative and nonoperative treatment of MEF to determine the effectiveness of each approach. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilized to query studies published between January 2019 and August 2025. All relevant outcome data were extracted. Frequency-weighted mean values with SD for commonly reported outcomes were calculated to demonstrate general trends across studies. Results: Eighteen studies with 1372 patients meeting inclusion criteria were included. In total, 1195 patients were treated operatively, with 177 treated nonoperatively. In nonoperative patients, the most common complications were nonunion (N=53, 29.9%) and range of motion loss/stiffness (N=10, 5.6%). The most common complications in surgical patients included ulnar nerve symptoms (N=76, 6.4%) and range of motion loss/stiffness (N=52, 4.4%). Secondary surgery due to complications occurred in 152 operative cases (13%). Four operative studies (N=245) reported ROM (flexion) numerically, resulting in a frequency-weighted average score of 133.2±12.7 degrees. Three operative studies (N=219) reported ROM (extension deficit) numerically, with a frequency-weighted average score of −1.74±5.8 degrees. Five studies directly compared ROM in operative versus nonoperative patients, with 4 finding no significant differences at final follow-up. Six studies (N=357) reported MEPS values for operative patients, resulting in a weighted mean average of 95.2±6.0. Three studies (N=110) reported MEPS values for nonoperative patients, resulting in a weighted mean average of 98.6±0.7. Conclusions: There continues to be no consensus on optimal management of isolated MEFs in pediatric patients though a recent trend in the literature towards more operative management. Each approach carries its own unique risks, though complications are infrequent. In general, functional outcomes were excellent in both surgically and nonsurgically managed patients, reflected in MEPS scores and ROM, among other measures. Level of Evidence: Level III—systematic review.
Benaroch et al. (Mon,) studied this question.