Medial Epicondyle Fractures-To Fix or Not to Fix

Medial epicondyle fractures are often written about and frequently discussed. The outcomes for these fractures do not clearly follow the over-arching themes for the management of displaced fractures in orthopaedics. Even in the face of a high nonunion rate, many patients treated conservatively with displaced fractures clinically perform well long term and show a low rate of elbow instability. The acceptable indications for conservative management include minimally displaced fractures, low energy injury, and a stable elbow. Fractures treated surgically have equally high rates of good and excellent outcomes with a higher rate of bony union. Fractures that should be treated surgically include those that are incarcerated as well as those that are open. There should be consideration for surgical management in patients with an ulnar nerve injury, the dominant arm in the overhead athlete and those that demonstrate valgus instability. Efforts should be made to avoid prolonged immobilization to minimize the risk of elbow motion loss. (C) 2019 Elsevier Inc. All rights reserved.