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Chronic Medial Epicondyle Avulsion

Technique of Fragment Excision and Ligament Reconstruction With Internal Brace Augmentation

Mirzayan, Raffy, MD; Cooper, Joseph D., MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: January 15, 2019 - Volume 27 - Issue 2 - p e64–e69
doi: 10.5435/JAAOS-D-17-00446
Review Article

Medial epicondyle fracture nonunions of the elbow may lead to symptomatic instability in the high-demand or overhead athlete. These injuries are challenging to treat surgically because of the small residual bony fragment, the scarred and shortened chronically injured ulnar collateral ligament (UCL), which prevents it from being mobilized and reduced to its native position. To date, most described methods aim at reducing the displaced fragment and achieving union with the humerus. This usually can only be accomplished by releasing of the scarred UCL to mobilize the fragment. The scarred and attenuated residual ligament is then repaired to restore stability but is often inadequate to sustain high-level valgus loads. We describe a technique of excision of the bony fragment and UCL reconstruction with allograft, augmented with internal brace to provide medial stability to the elbow. The described method allows proper tensioning of the graft and provides immediate and secure fixation.

From the Kaiser Permanente Southern California (Dr. Mirzayan), Baldwin Park, CA, and the University of Southern California Keck School of Medicine (Dr. Cooper), Los Angeles, CA.

Dr. Mirzayan or an immediate family member is a member of a speakers' bureau or has made paid presentations on behalf of Arthrex; has stock or stock options held in AlignMed; and has received research or institutional support from Arthrex and the Joint Restoration Foundation. Neither Dr. Cooper nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article.

© 2019 by American Academy of Orthopaedic Surgeons
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