From the Research
The recommended treatment for a medial epicondyle fracture typically involves immobilization with a posterior splint or long arm cast with the elbow flexed at 90 degrees and the forearm in neutral rotation for 2-3 weeks, as prolonged immobilization time is associated with decreased chance of regaining full range of motion 1.
Key Considerations
- For non-displaced or minimally displaced fractures (less than 5mm displacement), conservative management with immobilization is usually sufficient.
- The splint should extend from the upper arm to the palm, maintaining proper alignment while allowing for initial swelling.
- Pain management includes NSAIDs such as ibuprofen (400-600mg every 6 hours) or naproxen (500mg twice daily), along with acetaminophen (650-1000mg every 6 hours) as needed.
- Ice should be applied for 15-20 minutes several times daily during the first 48-72 hours to reduce swelling.
Post-Immobilization Care
- After the immobilization period, gentle range of motion exercises should begin, gradually progressing to strengthening exercises over the following 4-6 weeks.
- Displaced fractures (greater than 5mm), those with joint instability, or fractures in high-level athletes may require surgical fixation instead of splinting.
Evidence-Based Recommendations
- A recent study found that increased immobilization time was the only independent predictor of residual elbow stiffness following medial epicondyle fractures in children, independent of treatment strategy and receiving physical or occupational therapy 1.
- Another study suggested that surgical treatment may provide an avenue for consistently regaining full range of motion when treating these fractures, especially in the setting of concomitant dislocation 1.
- However, the optimal treatment strategy for pediatric medial epicondyle fractures remains controversial, and further study is required to standardize the measurement of displacement and to clarify indications for operative treatment in both sedentary and active children 2, 3.