ImportancePhyseal elbow injury remains common for the youth athlete. In this patient population, the most effective treatment strategy for these injuries is not established.ObjectiveThis systematic review aimed to synthesise current literature regarding treatment and outcomes of physeal elbow injuries in the skeletally immature athlete.Evidence reviewA systematic literature review was completed using two databases (PubMed and ScienceDirect). Search terms included ‘paediatric elbow injury’, ‘adolescent elbow injury’, ‘elbow physeal injury’, ‘avulsion fracture medial epicondyle’ and ‘little league elbow’. Inclusion criteria were: English language, Level of Evidence I–IV, physeal elbow injury as a direct consequence of athletic activity, involvement of a distinct treatment modality and/or outcome, publication after 1989 and skeletal immaturity demonstrated through radiographic measurements.FindingsTwelve studies consisting of treatment of avulsion fractures of the medial epicondyle, medial epicondyle fragmentation, olecranon stress fractures and olecranon apophysitis met criteria and were included in this study. The most common injury was avulsion fracture of the medial epicondyle. Of these patients, 68.5% underwent operative fixation with average return to play at 3.3 months and 31.5% underwent non-operative treatment with an average return to play of 8.4 months. For medial epicondylar fragmentation, 90.2% of patients were treated non-operatively with average return to play at 3.8 months. Operative intervention was performed on 85.7% of patients with olecranon epiphysial stress fractures and average return to play was at 7 months. Operative intervention was performed on 87.5% of patients with persistence of the olecranon physis with average return to play of 4 months. All cases of olecranon apophysitis were treated non-operatively and return to play was not documented.Conclusions and relevanceThis systematic review demonstrates the heterogeneity of the treatment options for physeal injury in the adolescent athlete. This analysis supports that operative management may expedite return to play for avulsion fracture of the medial epicondyle, though medial epicondylar stress fractures can be successfully managed non-operatively. Limited data suggest surgical intervention of olecranon epiphysial stress fractures and persistence of the olecranon physis may allow athletes faster return to play.Level of evidenceIV.
Medial Epicondyle Avulsion Fracture with Joint Entrapment in Children
