Symptomatic medial epicondyle nonunion: treatment by open reduction and fixation with a tension band construct

HypothesisNonunion of the medial epicondyle can cause symptoms of pain and instability in certain high-demand individuals. Problems with open reduction and internal fixation (ORIF) have led some to recommend excision of the nonunited fragment, followed by soft tissue repair. This study tests the hypothesis that patients with symptomatic nonunion of the medial epicondyle can be successfully treated with ORIF using a tension band construct.MethodsFive male patients were identified who underwent ORIF of a chronic, nonunited medial epicondyle fracture. Patients were a mean age of 15.8 years at presentation. The time since the original injury averaged 24 months.ResultsAt an average follow-up of 31 months, all patients reported satisfaction with their surgery. All nonunions healed, and the average postoperative extension improved significantly compared with preoperative values (P < .05). Disabilities of Arm, Shoulder and Hand scores were low (mean, 0.8) and Mayo Elbow Performance scores were high (mean, 100) at follow-up. No patient complained of prominent hardware or ulnar nerve irritation. All patients were able to return to high levels of physical activity, including one who qualified for the US Marine Corps.DiscussionNonunion of the medial epicondyle can be symptomatic in certain high loading individuals. Surgical repair of the united fragment is difficult due to anatomical and biomechanical factors.ConclusionWe believe that ORIF of chronic medial epicondyle nonunions using a tension band construct is a viable option in the symptomatic, high-demand patient.