Operative and Nonoperative Treatment of Pediatric Medial Epicondyle Fractures in Athletes: A Systematic Review

Abstract

It is still not clear what the most effective treatment is for fractures of the medial epicondyle in young athletes since fixation, although it helps to achieve bony healing, may lead to problems related to the implant. We conducted a search of PubMed/MEDLINE and PubMed Central up to 13 September 2026. Returning to the sport at the previous level was the main outcome measure. We also looked at return time, function, the occurrence of nonunion, range of motion, symptoms involving the ulnar nerve, and the need for additional surgery. The groups of athletes were considered apart from the more general comparative evidence.
Three cohorts of athletes consisted of 91 patients. In a propensity-matched comparison, 92.9 per cent of the patients in each of the treatment groups returned to the sport they had previously been playing, with the same return times and at a similar competitive level. All 14 of the overhead athletes in the smaller group returned irrespective of the treatment received. In the series which included only operative treatment, 28 out of the 29 overhead athletes had returned after an average of seven months. A randomized trial with 334 children found that there was no clinically important improvement in function at one year, even though further operations and higher costs were incurred. The higher rate of radiographic union following surgery was not consistently associated with better function or greater participation in sport.
In the case of a fracture that is generally stable and only moderately displaced without any fragment being incarcerated, the fact that the athlete is able to participate in sport alone is not a sufficient reason for carrying out routine surgical fixation. Treatment without surgery will nevertheless allow a high rate of return to sporting activities. Surgery may, however, be considered when there is objective instability, when there is a reliably measurable considerable displacement, or when there is a significant valgus deformity in the dominant arm, on the condition that the family is made aware of the possibility of needing further surgery later on.