Surgical Versus Nonsurgical Management of Pediatric Medial Epicondyle Fractures: An Updated Systematic Review.
Lee R Benaroch, Ronan J Anderson, Derek Di Iorio et al.
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In 30 seconds
This Level III systematic review compared operative and nonoperative management of isolated medial epicondyle fractures in children. It included 18 studies and 1372 patients: 1195 treated surgically and 177 nonsurgically. Functional outcomes were generally excellent with either approach. Among five studies directly comparing range of motion, four found no significant difference at final follow-up. Nonunion was the most common reported complication with nonoperative care (29.9%); ulnar nerve symptoms were most common after surgery (6.4%), and 13% of operative cases underwent secondary surgery for complications.
Key findings
- Nonoperative treatment was associated with nonunion in 53 patients (29.9%) and range-of-motion loss or stiffness in 10 (5.6%).
- After surgery, ulnar nerve symptoms occurred in 76 patients (6.4%), range-of-motion loss or stiffness in 52 (4.4%), and 152 cases (13%) required secondary surgery for complications.
- Four of five studies comparing range of motion found no significant difference between treatment groups at final follow-up.
- Weighted mean MEPS was 95.2±6.0 for operative patients and 98.6±0.7 for nonoperative patients.
Why it matters
The review highlights that both approaches can yield excellent function, while their reported complication profiles differ. The lack of consistent range-of-motion differences in direct comparisons underscores the uncertainty around choosing surgery over nonsurgical care for isolated pediatric fractures. These findings help frame shared clinical assessment of potential benefits and harms without establishing one approach as superior.
What to keep in mind
The evidence comes from 18 studies with markedly unequal treatment groups (1195 operative versus 177 nonoperative patients); the abstract does not report randomized comparisons.