Women medial epicondyle fracture w severe dislocation

[Dee243]

Hola - long time lurker, first time poster. DD age 10 was working on her roundoff-back handspring-back tuck with a coach and i guess the roundoff felt off and she tried to pull up on the handspring and then the coach heard the pop and well one ER visit later here we are.

They reduced her dislocation in the ER and we followed up with Ortho 1 who said surgery followed by a month in a cast and two months Therapy. And then surgery 2 to remove.

Second opinion doc the next day said data is showing no better outcome with surgery than without even in athletes and he said if it was his kid he would leave it. Come back next week, we would remove the splint and begin therapt. He noted surgery would be appropriate too - just not his recommendation.

Her bone piece is 9mm displaced.

I then sent the X-rays to my cousin in another state -he is an Ortho but not pedi -and he said surgery because she is a gymnast.

A college friend saw me post on social media asked for the X-rays and at first thought based on activity and age it would be surgery but then he saw the images and said better to leave it alone.

So actual orthopedic doctors that have viewed her x-rays are 2-2. We have a third doc apt on Monday.

So I have questions:

*Anyone in the 5-10mm range not do surgery? How did that work out?

*If you did surgery -did you get a cast? For how long. doc 1 timeline of a month in a cast seems long based on scientific papers I’ve read and some posts on this board.

Any BTDT would be appreciated.

 

[rsm]

DD was displaced just at 5mm. First doc said no surgery up to 5mm and she was just on the cusp, but decided against it because of her age. She was supposed to be in a splint for a month. Two weeks after the injury we saw another doc who said she would have recommended surgery, but after 2 weeks, enough healing had taken place that she wouldn't recommend it at that time. But she did take her out the splint and put her in a brace to so she could have limited motion in the elbow. She started PT after 2 months. Some weight bearing and hanging on bars after 3 months, some tumbling after 4 months, competed level 8 after 5 months. Had I done more reading earlier on, I would probably have asked for surgery, but I think it turned out fine for her. She is about 5 degrees off from full range of motion (flexion and extension). Good luck with whichever way you decide. While not having surgery was a relief, the recovery time was also a little longer because she couldn't push as hard with PT and strength.

 

[Dee243]

Hmm - interesting. Glad it worked out for her.

I think I was thinking no surgery meant faster recovery -but it makes sense that that’s not quite right.

I was thinking surgery would be a stronger move not faster.

Of course surgery is not without risks.

 

[rsm]

Hmm - interesting. Glad it worked out for her.

I think I was thinking no surgery meant faster recovery -but it makes sense that that’s not quite right.

I was thinking surgery would be a stronger move not faster.

Of course surgery is not without risks.

Gym can't do a lot without her arm being able to straighten completely (or very close). And PT can progress a little faster with a pin in place. I don't think it's a huge difference in overall time. And, yes, surgery has its own risks.

 

[tpMom]

My youngest DD had a supacondular fracture with less than 5mm displacement and ended up needing surgery to pin it in place. They said it was a judgement call whether or not to do surgery and I am very glad we opted to repair it surgically. Within 5 weeks the cast was off and she had full range of motion after 7 weeks. She was fully weight bearing by 12 weeks. Another little girl had a similar fracture, opted against surgery and still can't straighten her elbow or even rotate her arm with full range of motion. Obviously these fractures are different than your daughter's, especially because they were above the elbow and required casting from armpit to finger tips, but surgery definitely improved her healing time and range of motion.

 

[Dee243]

Oh - good to know - the comparison is helpful even though I know each injury is different.

It would be nice - but by no means necessary if she got in just one meet in late April next year, I think that would go a long way for her feeling like she didn’t just miss the season.

 

[NY Dad]

My youngest DD had a supacondular fracture with less than 5mm displacement and ended up needing surgery to pin it in place. They said it was a judgement call whether or not to do surgery and I am very glad we opted to repair it surgically. Within 5 weeks the cast was off and she had full range of motion after 7 weeks. She was fully weight bearing by 12 weeks. Another little girl had a similar fracture, opted against surgery and still can't straighten her elbow or even rotate her arm with full range of motion. Obviously these fractures are different than your daughter's, especially because they were above the elbow and required casting from armpit to finger tips, but surgery definitely improved her healing time and range of motion.

My dd also had a supacondular fracture. I don't know the amount of displacement but we were told that she didn't need pins but they would monitor (X-ray) every few days for the fist 10 (approx.) days. If the bone slipped they would reposition it and pin it. For the first 2 weeks they basically wanted her to stay off her feet as much as possible. I'm not a doctor but based on my own Google searching (which is a dangerous thing) it does appear to be a best practice to pin since there are very few drawbacks to pinning (infection being one of them). Her ortho said it wasn't necessary so I dropped it.

My dd has limited flexion (she can't touch her hand to the same shoulder). We went to a few specialists about that and had her X-rays reviewed by more than one orthopedist. Their conclusion was that my dd's bone was never properly set in the first place. It didn't slip. My point is that if a kid has limited elbow mobility it may not have anything to do with whether or not it was pinned.

I also agree, for the first approx. 2 months I did get the impression from the PT that they had to be a lot more conservative with return to weight bearing without pins.

 

[Dee243]

Thanks everyone!
I’m leaning towards surgery but terrified of putting her under if I don’t have to!!

 

[Deleted member D3987]

Hola - long time lurker, first time poster. DD age 10 was working on her roundoff-back handspring-back tuck with a coach and i guess the roundoff felt off and she tried to pull up on the handspring and then the coach heard the pop and well one ER visit later here we are.

They reduced her dislocation in the ER and we followed up with Ortho 1 who said surgery followed by a month in a cast and two months Therapy. And then surgery 2 to remove.

Second opinion doc the next day said data is showing no better outcome with surgery than without even in athletes and he said if it was his kid he would leave it. Come back next week, we would remove the splint and begin therapt. He noted surgery would be appropriate too - just not his recommendation.

Her bone piece is 9mm displaced.

I then sent the X-rays to my cousin in another state -he is an Ortho but not pedi -and he said surgery because she is a gymnast.

A college friend saw me post on social media asked for the X-rays and at first thought based on activity and age it would be surgery but then he saw the images and said better to leave it alone.

So actual orthopedic doctors that have viewed her x-rays are 2-2. We have a third doc apt on Monday.

So I have questions:




*Anyone in the 5-10mm range not do surgery? How did that work out?

*If you did surgery -did you get a cast? For how long. doc 1 timeline of a month in a cast seems long based on scientific papers I’ve read and some posts on this board.

Any BTDT would be appreciated.

surgery. she's a gymnast.

 

[CoachAlex]

I am not a doctor. My suggestion - if possible - is to find a pediatric or regular ortho who specializes in sports medicine. No, it doesn't sound like a complicated procedure but a doctor used to working with athletes will probably be most up to date on any data regarding ATHLETES with this type of injury. I know you said that you are going to see a third doc already, so hope they can help you guys out!

 

[Dee243]

I am not a doctor. My suggestion - if possible - is to find a pediatric or regular ortho who specializes in sports medicine. No, it doesn't sound like a complicated procedure but a doctor used to working with athletes will probably be most up to date on any data regarding ATHLETES with this type of injury. I know you said that you are going to see a third doc already, so hope they can help you guys out!

Thank you. Both doctors that we have seen are pediatraric sports specialists, recommended by others in my gym. The third doc is also one. We are fortunate to live in a large metro area with 5 or 6 docs that are pedi sports specialists.

 

[Jules]

Poor thing. Mine had that same injury, popped the elbow back but then saw also fractured. Had surgery and fixed it with K wire. 4 weeks in a cast then a quick op to remove the wire. It probably was 2 months therapy to get the arm straight, sort out proprioception and strengthen it, but it really was as good as new (apart from the scar, which she's quite proud of!). Good luck! x

 

[Dee243]

Oh good to know. I saw another thread with others that commented a much shorter cast time- so you are the only one that I’ve seen with pretty much what my Doc 1 said. Except screw instead of Kwire. Thank you.

 

[luvmygymmie]

My daughter had surgery for a medial epicondyle fracture with displacement around 10mm when she was a Level 8 gymnast. The ortho consult in the ER recommended no surgery and casting, but a follow-up appointment with a sports medicine orthopedic surgeon recommended surgery. I was not at all surprised given what I was reading in the literature---if there is displacement greater than 5mm in a gymnast or baseball player surgery is highly recommended. Her ortho was very clear that given the degree of displacement and her level of gymnastics, her elbow would not heal sufficiently and she would re-injure. She was released for full activity at 3 months post-surgery, but started slowly re-introducing skills under the careful eye of her physical therapist before 3 months. 2 pieces of advice: 1- get medical advice from a sport medicine ortho who understands the stress gymnasts place on their elbows and 2-read scientific literature as this made our decision very easy because the research is pretty convincing. Another thing to keep in mind is that elbows tend to lock up pretty quickly and her ortho did not want her immobilized for very long at all. In fact, a week after surgery she was doing range of motion exercises-I can't imagine how hard that would have been if she had been casted for weeks! Good luck and quick healing!

 

[Dee243]

My daughter had surgery for a medial epicondyle fracture with displacement around 10mm when she was a Level 8 gymnast. The ortho consult in the ER recommended no surgery and casting, but a follow-up appointment with a sports medicine orthopedic surgeon recommended surgery. I was not at all surprised given what I was reading in the literature---if there is displacement greater than 5mm in a gymnast or baseball player surgery is highly recommended. Her ortho was very clear that given the degree of displacement and her level of gymnastics, her elbow would not heal sufficiently and she would re-injure. She was released for full activity at 3 months post-surgery, but started slowly re-introducing skills under the careful eye of her physical therapist before 3 months. 2 pieces of advice: 1- get medical advice from a sport medicine ortho who understands the stress gymnasts place on their elbows and 2-read scientific literature as this made our decision very easy because the research is pretty convincing. Another thing to keep in mind is that elbows tend to lock up pretty quickly and her ortho did not want her immobilized for very long at all. In fact, a week after surgery she was doing range of motion exercises-I can't imagine how hard that would have been if she had been casted for weeks! Good luck and quick healing!

Thank you. I’m hoping our doc today doesn’t want to cast for weeks. She’s already been splinted for almost a week!

Was she in a splint for range of motion activities? Or no cast at all? Or a cast for a week?

 

[luvmygymmie]

For the week following surgery, she was in a hard splint and then in a brace that she was supposed to "unlock" several times a day to do range of motion. If I recall correctly, she only wore the brace for 6 weeks but even then was in PT and doing range of motion exercises throughout the day. I should say that the doctor originally said 6 months until full return to sport but she was released after 3 months because she had full range of motion and normal strength--the literature says full return to sport is expected anywhere from 3 to 6 months post surgery.

 

[Dee243]

Thanks! That makes sense! Hoping to hear all that at today’s appt!! Fingers crossed!

 

[Dee243]

Thanks everyone. After visiting with 3 doctors (all pedi sports orthos) we are scheduled for surgery later this week.

None of the docs offered immediate mobility with no cast. The doc we chose was potentially the shortest at
1 week splint,
2 weeks cast after
it being in a splint for a week before surgery.
I’m a little nervous about that- but at some point I have to pic a doctor and go with their plan. He was very aware about walking the line between holding it for healing and not letting it cease too much. And I like that his cast plan wasn’t set in stone and would depend on what he saw on X-rays.

Also a bit nervous because this doc wanted no lower body work while the cast was on. So we will have to hold that in tension with what the gym wants.

Thanks for the all the input.

 

[tpMom]

I'm glad you decided on a plan, good luck to your DD!

 

[e'smum]

good luck to your dd and with her surgery. prayers that her healing time is short and she bounces back quickly and can get in at least one meet this season! KUP!