Clinical outcomes of management of primary medial epicondylar fractures: A systematic review with meta-analysis.

PURPOSE: This analysis seeks to clarify the clinical efficacy of each treatment modality and inform evidence-based decision-making in the management of this common yet complex injury.

METHODS

A comprehensive systematic search was performed across major medical databases, including Medline (PubMed), Scopus, Web of Science, Embase, The Cochrane Library, ClinicalTrials.gov, and CINAHL Ultimate, to identify studies addressing the outcomes of treatment for primary medial epicondyle fractures.

RESULTS

A total of 65 studies published between 1982 and 2026 were included in the meta-analysis. The pooled incidence of fracture union rate following surgical treatment was 97% (95% confidence interval (CI): 95%-98%). Conservative immobilization resulted in a markedly lower union rate of 46% (95% CI: 20%-74%). The overall complication rate following surgical treatment was 21% (95% CI: 16%-27%), compared to 36% (95% CI: 13%-63%) for conservative immobilization.

CONCLUSION

Among surgical options, screw fixation was associated with high union rate and the lowest complication profile, with statistically distinct pooled estimates supporting its reliability in achieving stable healing and early mobilization. We believe that the pooled estimates from our study will be valuable in guiding clinical decision-making and will help assess the risk of potential outcomes and complications in patients with medial epicondyle fractures.

SIGNIFICANCE OF STUDY: This study provides high-quality pooled evidence comparing surgical and conservative management of medial epicondyle fractures, helping clinicians make more informed, evidence-based decisions by clarifying differences in union rates, functional outcomes, and complication risks.