Clinical Outcomes and Return to Play in Youth Overhead Athletes After Medial Epicondyle Fractures Treated With Open Reduction and Internal Fixation.

Background: There is limited literature regarding outcomes after operative treatment of displaced medial epicondyle avulsion fractures in adolescent athletes. Most studies have had a relatively small sample size and have not assessed return to play of the overhead athlete.

Purpose: To examine return to play and outcomes of youth overhead athletes who underwent open reduction and internal fixation (ORIF) with screw fixation.

Study Design: Case series; Level of evidence, 4.

Methods: Charts and radiographs were queried between January 2003 and June 2018 for young overhead athletes (age, <17 years) who underwent ORIF for displaced medial epicondyle fracture. Patients with open fracture or concomitant injury were excluded. Radiographs from postoperative follow-up visits were examined for radiographic union. Eligible patients were asked to provide responses to the American Shoulder and Elbow Surgeons Standardized Assessment Elbow questionnaire and Kerlan-Jobe Orthopaedic Clinic questionnaires as well as questions regarding return to play.

Results: Overall, 29 patients were included in the study; the mean age at surgery was 14.7 years (range, 12.9-16.5 years). There were 25 baseball players, 3 football quarterbacks, and 1 tennis player. Of the 23 patients with available images at least 3 months after surgery, 96% demonstrated radiographic union at last follow-up. Imaging for the 1 patient with nonunion was taken 3 months after ORIF, and it is unknown if he eventually had union. All patients (100%) were successfully contacted to complete questionnaires at a mean follow-up of 4.8 years (range, 1.0-13.5 years). The mean KJOC score was 93.0, and the mean scores for the American Shoulder and Elbow Surgeons Elbow questionnaire were 8.9, 35.6, and 9.8 for pain, function, and satisfaction, respectively. One overhead athlete did not return to play, while the other 28 returned at a mean 7 months after surgery. No patient underwent revision ORIF, 1 underwent hardware removal, and 1 underwent ulnar nerve transposition. No players underwent ulnar collateral ligament reconstruction after primary ORIF of the medial epicondyle.

Conclusion: ORIF of displaced medial epicondyle fractures is a reliable and successful procedure in adolescent overhead athletes with high demands, with relatively low risk of major complications, reinjury, or reoperation.