Is computed tomography necessary for diagnostic workup in displaced pediatric medial epicondyle fractures?

Abstract

This study aimed to compare the treatment outcomes and complications between operatively and nonoperatively treated medial epicondyle fractures with displacement of >5 mm as accurately measured on three-dimensional computed tomography (3D CT). We retrospectively reviewed 77 patients who had isolated medial epicondylar fractures with displacement of >5 mm. The mean age at injury was 11.4 years. Patients were assigned to one of two groups: 21 patients treated nonoperatively and 56 patients treated surgically. Additionally, patients treated operatively were divided into two subgroups according to fixation method; 31 patients underwent internal fixation with K-wires and 25 patients underwent internal fixation with a screw. Radiological and functional outcomes were compared among the three groups. Although the bony union rate was significantly higher in patients treated operatively compared to patients treated non-operatively (96.4% vs. 23.8%, p < 0.001), there were no significant differences in functional outcomes between the two groups. In the nonoperative group, three patients underwent osteosynthesis for symptomatic nonunion. There were no significant differences in radiological and functional outcomes between the two subgroups divided by fixation method. In a pediatric medial epicondylar fracture with a displacement of >5 mm as accurately measured on 3D CT, despite the difference in union rate, there was no difference in functional outcomes between operative and nonoperative treatment. Performing CT only to measure the fracture displacement in obviously displaced medial epicondylar fracture is not considered as a part of the “necessary” diagnostic workups.