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Washers do not affect the rate of implant removal or elbow motion in medial epicondyle fractures

Patel, Neeraj M.a; Gajewski, Christopher R.b; Ascoli, Anthony M.b; Lawrence, J. Todd R.b

Journal of Pediatric Orthopaedics B: November 2019 - Volume 28 - Issue 6 - p 526–529
doi: 10.1097/BPB.0000000000000655

The use of a washer to supplement screw fixation can prevent fragmentation and penetration during the surgical treatment of pediatric medial epicondyle fractures. However, concerns may arise regarding screw prominence and the need for subsequent implant removal. The purpose of this study is to evaluate the impact of washer utilization on the need for hardware removal and elbow range of motion (ROM). All pediatric medial epicondyle fractures treated with a single screw over a 7-year period were queried for this retrospective case-control study. Hardware removal was performed only if the patient experienced a complication or implant-related symptoms that were refractory to non-operative management. Of the 137 patients included in the study, a washer was utilized in 90 (66%). Thirty-one patients (23%) ultimately underwent hardware removal. There was not an increased need for implant removal in those with a washer (P = 0.11). When analyzing a subgroup of 102 athletes only, there was similarly no difference in the rate of implant removal if a washer was used (P = 0.64). Overall, 107 (78%) patients regained full ROM at a mean of 13.9 ± 9.7 weeks after surgery with no significant difference along the lines of washer use. Use of a washer did not affect the need for subsequent implant removal or elbow ROM after fixation of medial epicondyle fractures, even in athletes. If there is concern for fracture fragmentation or penetration, a washer can be included without concern that future unplanned surgeries may be required.

aAnn & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois

bThe Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

Correspondence to J. Todd R. Lawrence, MD, PhD, Division of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA Tel: +1 215 590 1000; fax: +1 215 590 1501; e-mail:

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