Zheng Evan T, Bae Donald S, Yen Yi-Meng, Vuillermin Carley B, Miller Patricia E, Heyworth Benton E
Harvard Medical School, Boston, Massachusetts, USA.
Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
Orthop J Sports Med. 2025 Sep 9;13(9):23259671251365974. doi: 10.1177/23259671251365974. eCollection 2025 Sep.
Medial epicondylar apophyseal avulsion fractures of the distal humerus represent an understudied severe variant of elbow overuse injury in youth throwers.
To characterize medial epicondylar apophyseal avulsion fractures in a population of youth throwers, as well as to describe outcomes after both operative and nonoperative treatment.
Case series; Level of evidence, 4.
Skeletally immature athletes with a medial epicondylar apophyseal avulsion fracture sustained during throwing from 2003 to 2017 at a tertiary care pediatric referral center were identified. Exclusion criteria were injuries sustained during nonthrowing events or previous elbow fractures. Patients treated operatively were compared with those treated nonoperatively, and the overall study population was compared with a control group of patients diagnosed with medial epicondylar apophysitis only, with no fracture.
A total of 50 patients with medial epicondylar avulsion fractures (100% male; 49 baseball pitchers, 1 football quarterback) were identified. These patients had higher body mass index (BMI) than the control group with medial epicondylar apophysitis only. Of the 37 avulsion fracture patients with documentation regarding presence or absence of preoperative symptoms, 31 patients (84%) reported preexisting elbow pain before their acute injury. Of the 12 patients who underwent shoulder exams at presentation, 5 (42%) demonstrated glenohumeral internal rotation deficit (GIRD). Of the total 50 patients, 22 (44%) underwent open reduction and internal fixation (ORIF) with a single cannulated screw, 1 (2%) patient underwent suture-based fixation, and 27 (54%) patients were treated nonoperatively. For each additional millimeter of displacement, the odds of surgical intervention increased by 6.4 times (odds ratio, 6.36; 95% CI, 1.83-22.07; = .004) when controlling for age and BMI. All patients returned to sports, with no significant difference in recurrent elbow pain between cohorts, although 41% of applicable ORIF patients (9 of 22) underwent secondary screw removal.
Displaced medial epicondylar apophyseal avulsion fractures in youth throwers may be effectively treated with operative screw fixation, although >40% of patients may require secondary screw removal. Nonoperative treatment may be appropriate for minimally displaced cases. Given that a large majority of patients reported preexisting elbow pain, and a substantial cohort demonstrated GIRD, this severe presentation of Little League elbow may be preventable.
肱骨远端内侧髁骨骺撕脱骨折是青少年投掷运动员肘部过度使用损伤中一种研究较少的严重类型。
描述青少年投掷运动员群体中内侧髁骨骺撕脱骨折的特征，并描述手术和非手术治疗后的结果。
病例系列；证据等级，4级。
确定2003年至2017年在一家三级儿科转诊中心因投掷导致内侧髁骨骺撕脱骨折的骨骼未成熟运动员。排除标准为非投掷事件中受伤或既往肘部骨折。将接受手术治疗的患者与非手术治疗的患者进行比较，并将整个研究人群与仅诊断为内侧髁骨突炎而无骨折的对照组患者进行比较。
共确定50例内侧髁撕脱骨折患者（100%为男性；49名棒球投手，1名橄榄球四分卫）。这些患者的体重指数（BMI）高于仅患有内侧髁骨突炎的对照组。在37例有术前症状记录的撕脱骨折患者中，31例（84%）报告在急性损伤前就存在肘部疼痛。在就诊时接受肩部检查的12例患者中，5例（42%）表现为盂肱关节内旋不足（GIRD）。在总共50例患者中，22例（44%）接受了单枚空心螺钉切开复位内固定（ORIF），1例（2%）患者接受了缝线固定，27例（54%）患者接受了非手术治疗。在控制年龄和BMI的情况下，每增加1毫米的移位，手术干预的几率增加6.4倍（优势比，6.36；95%可信区间，1.83 - 22.07；P = .004）。所有患者均恢复运动，各队列之间复发性肘部疼痛无显著差异，尽管41%的适用ORIF患者（22例中的9例）接受了二次螺钉取出术。
青少年投掷运动员中移位的内侧髁骨骺撕脱骨折可通过手术螺钉固定有效治疗，尽管超过40%的患者可能需要二次螺钉取出。非手术治疗可能适用于轻度移位的病例。鉴于绝大多数患者报告有既往肘部疼痛，且相当一部分队列表现为GIRD，这种严重的小联盟肘部表现可能是可预防的。
