Operative Treatment of Displaced Medial Epicondyle Fractures Using K-Wires Cross-Fixation

Youn Moo Heo; Sang-Bum Kim; Jin Woong Yi; Jae Ik Lee; Hyun Jin Yoo; Tae Gyun Kim

doi:10.4055/jkoa.2015.50.6.513

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Heo, Kim, Yi, Lee, Yoo, and Kim: Operative Treatment of Displaced Medial Epicondyle Fractures Using K-Wires Cross-Fixation

Original Article

Journal of the Korean Orthopaedic Association 2015; 50(6): 513-519.

Published online: 29 December 2015

DOI: https://doi.org/10.4055/jkoa.2015.50.6.513

Operative Treatment of Displaced Medial Epicondyle Fractures Using K-Wires Cross-Fixation

Youn Moo Heo, M.D., Sang-Bum Kim, M.D., Jin Woong Yi, M.D., Jae Ik Lee, M.D., Hyun Jin Yoo, M.D., Tae Gyun Kim, M.D.

Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea.

Correspondence to: Tae Gyun Kim, M.D. Department of Orthopedic Surgery, Konyang University Hospital, 158 Gwanjeodong-ro, Seo-gu, Daejeon 35365, Korea. TEL: +82-42-600-9863, FAX: +82-42-600-9058, ktk1113@hanmail.net

Received 6 October 2014 Revised 7 March 2015 Accepted 20 July 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aim of this study was to investigate the clinical and radiological outcomes following reduction of displaced medial humeral epicondyle fracture with a K-wire cross-fixation.

Materials and Methods

Seventeen patients (mean age, 12.7 years; 12 boys and 5 girls) who underwent cross-fixation using K-wires in displaced medial epicondyle fracture, regardless of dislocation, were included. Surgical outcomes were estimated using the Elbow Assessment Score of the Japanese Orthopaedic Association. Statistical significance between the elbow assessment score and age, fracture type, dislocation, displacement width, and size difference between bilateral medial epicondyles was estimated 6 weeks after surgery.

Results

The mean elbow assessment score among the patients was 98 points (range, 94-100 points). Displaced medial epicondyle fractures were radiologically classified according to 3 groups: minimally displaced (2 cases), entrapped (9 cases), and associated with dislocation (6 cases). The mean displacement width of the fracture fragment was 11.6 mm. At 6 weeks postoperatively, the medial length of the distal humerus (28.6 mm) was greater compared to that of the contralateral side (28.1 mm). Displacement of the fracture fragment was statistically related to the elbow assessment score (p=0.011). The other assessed values did not show statistical meaning.

Conclusion

Open reduction of the displaced medial humeral epicondyle fracture using K-wire cross-fixation in children and adolescents showed favorable clinical results with no instability or elbow complications.

Keywords: humerus, medial epicondyle, fracture, K-wire, fixation

Figures and Tables

Figure 1

A 17-year-old male with a fracture in which bone fragment is positioned in the articular space. (A, B) Bone fragment positioned in the articular space, anteroposterior (AP) and lateral view. (C, D) Elbow was not reduced because of a bone fragment seen in AP and oblique view.

Figure 2

Pre- and postoperative state of a 17-year-old male. (A, C) Bone fragment positioned in the articular space, anteroposterior (AP) and oblique view. (B, D) Bone fragment was fixed by 4 K-wires seen in AP and oblique view.

Figure 3

Method for measurement of displacement degree of bone fragment and medial epicondyle width. (A) Displacement degree was defined as distance of between proximal point of the fractured site and the same point of bone fragment (a, proximal point of the fractured site in the humerus; b, same point in a fractured bone fragment; D, distance between a and b). (B) Medial width was measured like (m, midline of the humerus which was the longitudinal axis; p, apex of the medial epicondyle; L, length; U, ulna side; R, radial side).

Table 1

Demographics of Patients

Values are presented as number only or median (range).

Table 2

Elbow Assessment Score system (Japanese Orthopedic Association)

Table 3

Coefficient and Significance Probability between Elbow Assessment Score with Displacement and Medial Width

^*Medial distance in postoperative 6 weeks.

Notes

This article was announced at 2014 The Korean Orthopaedic Association Annual Fall Conference.

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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