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Rest and activity modification
79%
1406/1785
Long arm casting for 8 weeks
6%
109/1785
Fragment excision
1%
9/1785
Open reduction and internal fixation
10%
182/1785
Ligament reconstruction
4%
67/1785
Select Answer to see Preferred Response
This patient has little league elbow. Initial treatment should consist of rest, activity modification, decrease in innings pitched, and physical therapy. Little league elbow refers to a continuous spectrum of injuries to the medial side of the elbow seen in adolescent pitchers, which includes: medial epicondyle stress fractures, ulnar collateral ligament (UCL) injuries, and flexor-pronator mass strains. Diagnosis is made clinically with tenderness over the medial elbow made worse with valgus stress and supplemented with radiographs and MRI studies. Treatment is a trial of rest, activity modification, decrease in innings pitched, and physical therapy. Gottschalk et al. reviewed humeral medial epicondyle fractures in the pediatric population. They reported that relative indications for surgical fixation include ulnar nerve entrapment, gross elbow instability, and fractures in athletic or other patients who require high-demand upper extremity function. They concluded that absolute indications for surgical intervention are an incarcerated fragment in the joint or open fractures. Osbahr et al. reviewed medial elbow injury due to valgus overload in skeletally immature baseball players. They reported that medial epicondyle avulsion fractures can occur with a characteristic acute presentation while throwing in youth baseball players and that prevention may be possible when conforming to established USA Baseball youth pitching recommendations. They concluded that once an acute medial epicondyle avulsion fracture occurs, these injuries may be managed using published treatment algorithms, with successful return to play in less than 1 year. Figure A is a coronal MRI image depicting increased signal and physeal widening of the medial epicondyle consistent with little league elbow. Illustration A depicts widening of the medial epicondyle of the humerus seen in little league elbow Incorrect Answers: Answer 2: Long arm casting for a prolonged period of time would not be appropriate in this patient and may result in unnecessary elbow stiffness Answer 3: The medial epicondyle should be preserved due to its ligamentous and soft tissue attachments which provide elbow stability Answer 4: Open reduction and internal fixation is indicated for medial epicondyle avulsion fractures Answer 5: UCL reconstruction is indicated for UCL disruption and insufficiency
1.9
(10)
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