Casting vs. Surgery for Medial Epicondylar Fractures
Trial question
Is casting noninferior to open surgical reduction and internal fixation in children with displaced medial epicondylar fractures?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
60.0% female
40.0% male
N = 72
72 patients (43 female, 29 male).
Inclusion criteria: children with displaced medial epicondylar fractures.
Key exclusion criteria: joint incarceration; ulnar nerve dysfunction; pathological or open fractures; systemic bone disease; concomitant upper limb fractures requiring surgery; conditions precluding full participation in follow-up.
Interventions
N=35 casting (long-arm cast for 4 weeks only).
N=37 surgery (surgery within 7 days; open reduction and internal fixation, followed by long-arm cast for 4 weeks).
Primary outcome
Mean Quick Disabilities of Arm, Shoulder, and Hand score at 12 months
2.71 points
1.73 points
2.7 points
2.0 points
1.4 points
0.7 points
0.0 points
Casting
Surgery
Difference not exceeding
non-inferiority
margin ✓
Difference not exceeding non-inferiority margin in mean Quick Disabilities of the Arm, Shoulder, and Hand score at 12 months (2.71 points vs. 1.73 points; MD 0.98, 95% CI -0.98 to 2.95).
Secondary outcomes
Significant decrease in median cosmetic VAS score at 12 months (100 mm vs. 91 mm; MD -8.9, 95% CI -16.6 to -1.2).
No significant difference in mean elbow ROM at 12 months (141.1 degrees vs. 150.6 degrees; MD -9.5, 95% CI -26.27 to 7.27).
No significant difference in mean grip strength at 12 months (1.1 kg vs. 0.4 kg; MD 0.7, 95% CI -0.25 to 1.65).
Safety outcomes
No significant difference in diminished sensation postoperatively.
Significant difference in fracture nonunion at 12 months (68.6% vs. 2.7%).
Conclusion
In children with displaced medial epicondylar fractures, casting was noninferior to surgery with respect to mean Quick Disabilities of the Arm, Shoulder, and Hand score at 12 months.
Reference
Petra Grahn, Ilkka Helenius, Tero Hämäläinen et al. Casting vs Surgical Treatment of Children With Medial Epicondyle Fractures: A Randomized Clinical Trial. JAMA Netw Open. 2025 May 1;8(5):e258479.
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