Modified screw fixation technique for medial epicondyle fractures to reduce complications and improve stability of fixation.

Abstract

Purpose: Open reduction internal fixation of paediatric medial epicondyle (ME) fractures can be technically challenging. The pull of the common flexor origin, ulnar nerve proximity, narrow ideal screw trajectory and sometimes fragmented epicondyle piece can make reduction difficult and lead to complications. Concern for tenuous fixation can lead to longer immobilization, placing the elbow at risk of stiffness. We describe a modified technique for screw fixation of ME fractures, with the goal of reducing complications and improving the stability of fixation.

Methods: The modified technique includes insertion of a guidewire and pre-drilling for the screw prior to any fracture reduction, suture-assisted mobilization and control of the ME fragment, and conversion of the suture into a transosseous tension band to augment the screw fixation. A Retrospective chart review of 13 patients treated with this technique was undertaken to report early clinical and radiographic outcomes.

Results: The average age at surgery was 12 years (range: 6-15). The mean follow-up was 8 months (range: 1-17). There was 100% fracture union with an average time to union of 7 weeks (range: 4-13). All patients obtained a functional range of motion with median flexion of 140° and median extension of 0°. Five patients had screw removal during follow-up. One patient had symptomatic ulnar nerve instability that was addressed at screw removal. There were no other complications.

Conclusion: This technique improves ease of reduction and increases stability of fixation allowing earlier range of motion. This technique has provided reliable early results in our series of 13 patients.