Let them move: Early range of motion and rehabilitation after fixation of medial epicondyle fractures in adolescent athletes.

BACKGROUND

Medial epicondyle fractures account for 11%-20% of pediatric elbow fractures. While nonoperative treatment is effective, surgery is often recommended for overhead athletes to enhance union rates, valgus stability, and expedited return to sporting activities. Postoperative recovery protocols vary, with traditionally up to 2 weeks of strict immobilization and rehabilitation lasting 6-12 months. This study evaluates the early range of motion (ROM) and accelerated rehabilitation in high-performing youth athletes undergoing surgical fixation.

METHODS

A retrospective review included patients aged 12-17 who underwent medial epicondyle fracture fixation (2015-2023). Those with concomitant injuries were excluded. Recovery was assessed by unrestricted Return to Sports (RTS).

RESULTS

18 patients (mean age 14) were included. Postoperatively, all wore a hinged elbow orthosis locked at 90° flexion. At 1 week, extension was allowed to -30°, with flexion as tolerated. Physical therapy was initiated, focusing on gentle stretching to full ROM out of the brace. Patients remained in a hinged elbow brace for an average of 4.47 weeks before transitioning to a hinged sleeve or discontinuing brace use. After 4-6 weeks, physical therapy increased with emphasis on strengthening and terminal extension. For the 16 baseball players included, progressive return to throw and hit programs began at an average of 8.6 weeks. All patients returned to sports without restriction at an average of 13.4 weeks.

CONCLUSION

Early mobilization and accelerated rehabilitation following medial epicondyle fracture fixation facilitate a faster RTS in high-demand youth athletes.

LEVELS OF EVIDENCE IV: Case series.