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Long arm cast for 1 week, followed by passive and gentle active ROM
4%
119/3081
Placement in a hinged elbow brace with immediate active motion
1%
39/3081
Closed reduction followed by K-wire fixation
12%
380/3081
Open reduction and internal fixation
82%
2519/3081
Fragment excision and flexor/pronator mass re-attachment
0%
14/3081
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The clinical scenario and image depict a displaced medial epicondyle fracture. Surgical treatment indications based on displacement vary across the literature from 2 to 10 mm. Fracture fragment incarceration and open fractures are absolute indications while relative indications include valgus instability and ulnar nerve dysfunction. Non-operative treatment can lead to fibrous unions which may be symptomatic in some cases. Case et al reviewed 8 cases of adolescent displaced medial epicondyle fractures, all fixed a screw and washer with the initiation of motion in a hinged elbow brace on day 4 for 4 weeks. Half the patients had concomitant elbow dislocations. All patients went on to union, were pain-free and were stable to valgus and varus stressing. All patients returned to full sports activity. One patient lost 5 degrees of hyperextension compared to the contralateral elbow. Illustration A demonstrates a gravity valgus stress examination with marked instability of the medial elbow.
3.1
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