Suture Anchor Fixation Versus Screw Fixation in the Treatment of Pediatric Medial Epicondyle Fractures

Introduction: Medial epicondyle fractures are a common upper extremity injury seen in the pediatric population, accounting for 12-20% of all pediatric elbow fractures 1 .They typically occur in males ages 9-14 and result from either direct impact or a valgus force on the elbow leading to bony avulsion 1 .These injuries are associated with elbow dislocations and can be difficult to reduce anatomically secondary to incarcerated fragments 2 .In addition to irreducible fracture dislocations, operative indications for medial epicondyle have historically included open fractures, gross instability, ulnar nerve dysfunction, and fractures with >5 millimeters displacement 1,3,4 .It is important to note, however, that non-operative management of these injuries has gained increasing popularity in recent years with multiple studies finding clinically equivalent functional outcomes and lower complication rates relative to operative management 5,6 .Open reduction and screw fixation is the preferred method of surgical treatment for medial epicondyle fractures 1 .Fixation can also be achieved with K wires, but these carry the risks of backing out and pin site infection 5,6 .Some recent studies describe suture anchor fixation, although there is a relative paucity of outcomes data on this method of fixation [7][8][9] .In this study, we retrospectively reviewed pediatric patients who underwent operative fixation of medial epicondyle fractures by 3 surgeons at a level one trauma center.These patients were fixed using either screw fixation or suture anchor placement.The purpose of this study was to characterize and compare the outcomes and complications seen between these two fixation techniques.We hypothesized that suture anchor fixation would have similar outcomes compared to screw fixation with potentially lower rates of symptomatic hardware and reoperation.Methods: This study is a retrospective review of pediatric patients who underwent operative fixation of medial epicondyle fractures performed at a tertiary academic center between October 2017 and June 2025.Potential patients were identified via CPT codes for operative fixation of humeral epicondylar fractures, and these patients were manually reviewed to ensure that they met inclusion criteria.Exclusion criteria included any surgeries performed to address alternate fractures including lateral epicondyle fractures and medial condyle fractures, patients with no recorded follow-up, and patients older than 18 years old.Data was then separated into two groups: one group whose fractures were initially treated with screw fixation with or without washer and a second group who were initially treated with suture anchor fixation.Both fixation methods were accompanied by open reduction to attain anatomic alignment of the medial epicondyle.Patient information including demographics and past medical history was reviewed and compared.Fracture characteristics were also identified and compared between the two groups, including mechanism of injury, concurrent elbow dislocation, and fracture displacement/incarceration.Charts were reviewed to identify any postoperative complications. J o u r n a l P r e -p r o o f