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Displacement of greater than 5 mm
5%
187/3850
An incarcerated fragment in the ulnohumeral joint
88%
3390/3850
2+ valgus laxity seen with manual stressing
1%
28/3850
To prevent cubitus valgus deformity
3%
101/3850
High risk of symptomatic non-union of fragment
126/3850
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Medial epicondyle avulsion fractures can be treated with open reduction and internal fixation when the fractured fragment is incarcerated in the ulnohumeral joint or if there is significant ulnar nerve dysfunction. Figures A and B show a displaced medial epicondyle fracture that is incarcerated in the ulnohumeral joint, thus requiring ORIF. Lee et al studied 25 pediatric patients who had undergone ORIF of a medial epicondyle fracture and found no correlation between surgical outcome and injury mechanism, displacement, interval from injury to surgery, dislocation, fixation method, or duration of immobilization. All patients in this study had good to excellent outcomes. Farsetti et al compared pediatric patients with medial epicondyle fractures with displacement > 5mm who received a long arm cast without reduction, ORIF, and excision. They found no difference in long term results between patients treated with ORIF and those who received non-op treatment, while those treated with excision had poor long term results.
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