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Selected Publication:
Ortner, M.
Results in the Treatment of Medial Humeral Epicondyle Fractures in Children and Adolescents
Humanmedizin; [ Diplomarbeit ] Medical University of Graz; 2014. pp. 69
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- Authors Med Uni Graz:
- Advisor:
- Ruttenstock Elke Maria
- Singer Georg
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- Abstract:
- Purpose: Medial humeral epicondyle fractures (MHEF) in children and adolescents have been the objective of various studies in the past. Both, surgical and conservative treatments are offered, dependent on the type of MHEF fracture. While there exists common consensus on the conservative treatment for non-displaced MHEF and there have been established a number of absolute indications for surgery, many cases fall into a grey zone where recommendations for the appropriate treatment are still subject of discussion. The aim of our study was to retrospectively analyze the pediatric and adolescent population in our hospital treated for MHEF. The results achieved through conservative and surgical treatment approaches were compared to the literature, with the target of identifying possible areas for improvement. Patients and methods: We retrospectively reviewed patients’ data concerning injury, diagnosis, treatment and follow-up of MHEFs, treated in our clinic between the years 2004 and 2011. The data was grouped according to method of treatment in order to compare results and identify advantages and disadvantages of each method. Results: In total there were 81 patients treated for MHEF that met the inclusion criteria for the present study. Fifty-six patients (69.1%) were treated with open reduction and internal fixation (ORIF). Twenty-five patients (30.9%) were initially treated conservatively with immobilization. In 6 of these cases (24%) a conversion to ORIF was necessary at some point during treatment because of failure of the initial conservative treatment. Complications during and after the recovery process were rare and with little to no further clinical consequence. The treatment of MHEF in our hospital showed good clinical results in all treatment groups. Only one surgical case presented with complications that made a revision necessary. Conclusion: Based on the findings of our study, we agree to adhere to the well-established absolute indications for surgery. Both methods of treatment, ORIF and conservative approach, are equally eligible. However, rather than basing the decision for surgery mainly on the grade of dislocation, we recommend to implement clinical stability tests of the elbow joint in the decision process for surgery. While a surgical approach seems to provide higher chances for bony union, the functional outcome between surgery and conservative approach does not differ. This fact, as well as the avoidance of two surgical interventions and the possibility for a conversion at a later stage, leaves us with the conclusion, that especially in controversial cases of MHEF a conservative approach may be favorable.