Paediatric medial epicondyle fractures of the distal humerus

Medial humeral epicondyle fractures represent approximately 12% of elbow injuries in children. It is a controversial topic in paediatric fracture management, as there is a trend towards extending the indications for surgical management that is not supported by high-quality evidence. In fact, the current literature can be contradictory and consists of mainly retrospective studies including small numbers of patients. The only absolute indication for surgery is when the medial epicondyle fragment becomes incarcerated within the elbow joint. In this article, we will present the important anatomical, physiological and interventional factors to allow independent interpretation of the literature. The current literature will be reviewed and a pragmatic approach to treatment presented. Due to the porosity of the current evidence on medial epicondyle fractures high-quality research is urgently required in the form of a adequately power definitive randomized control trial.