Journal of Shoulder and Elbow Surgery
Volume 19, Issue 7 , Pages 951-957 , October 2010

Acute, avulsion fractures of the medial epicondyle while throwing in youth baseball players: A variant of Little League elbow

  • Daryl C. Osbahr, MD

      Affiliations

    • Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
  • ,
  • Peter N. Chalmers, BA

      Affiliations

    • School of Medicine, Columbia University-College of Physicians and Surgeons, New York, New York
  • ,
  • Jeremy S. Frank, MD

      Affiliations

    • Department of Orthopaedic Surgery, Children's Hospital Boston, Boston, Massachusetts
  • ,
  • Riley J. Williams III, MD

      Affiliations

    • Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
  • ,
  • Roger F. Widmann, MD

      Affiliations

    • Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
  • ,
  • Daniel W. Green, MD, FACS

      Affiliations

    • Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
    • Corresponding Author InformationReprint requests: Daniel W. Green, MD, FACS, Associate Professor, Hospital for Special Surgery, 535 East 70th Street, New York, New York 10021.

References 

  1. Adams JE. Little League Elbow. Calif Med. 1973;118:34–35
  2. Axe MJ. Recommendations for protecting youth baseball pitchers. Sports Med Arthrosc. 2001;9:147–153
  3. Brady J. Upper extremity: elbow injuries in children and adolescents. In:  Stanitski CL,  DeLee JC,  Drez D editor. Pediatric and adolescent sports medicine. Philadelphia: W.B. Saunders Co; 1994;p. 538
  4. Brogdon BG, Crow NE. Little leaguer's elbow. Am J Roentgenol Radium Ther Nucl Med. 1960;83:671–675
  5. Cain EL, Dugas JR, Wolf RS, Andrews JR. Elbow injuries in throwing athletes: a current concepts review. Am J Sports Med. 2003;31:621–635
  6. Case SL, Hennrikus WL. Surgical treatment of displaced medial epicondyle fractures in adolescent athletes. Am J Sports Med. 1997;25:682–686
  7. Escamilla RF, Barrentine SW, Fleisig GS, Zheng N, Takada Y, Kingsley D, et al. Pitching biomechanics as a pitcher approaches muscular fatigue during a simulated baseball game. Am J Sports Med. 2007;35:23–33
  8. Farsetti P, Potenza V, Caterini R, Ippolito E. Long-term results of treatment of fractures of the medial humeral epicondyle in children. J Bone Joint Surg Am. 2001;83:1299–1305
  9. Fowles JV, Kassab MT. Displaced fractures of the medial humeral condyle in children. J Bone Joint Surg Am. 1980;62:1159–1163
  10. Fowles JV, Slimane N, Kassab MT. Elbow dislocation with avulsion of the medial humeral epicondyle. J Bone Joint Surg Br. 1990;72:102–104
  11. Gilchrist AD, McKee MD. Valgus instability of the elbow due to medial epicondyle nonunion: treatment by fragment excision and ligament repair—a report of 5 cases. J Shoulder Elbow Surg. 2002;11:493–497
  12. Gugenheim JJ, Stanley RF, Woods GW, Tullos HS. Little League survey: the Houston study. Am J Sports Med. 1976;4:189–200
  13. Hang DW, Chao CM, Hang YS. A clinical and roentgenographic study of Little League elbow. Am J Sports Med. 2004;32:79–84
  14. Hang YS. Little league elbow: a clinical and biomechanical Study. Int Orthop. 1982;3:70–78
  15. Haxhija EQ, Mayr JM, Grechenig W, Hollwarth ME. Treatment of medial epicondylar apophyseal avulsion injury in children. Oper Orthop Traumatol. 2006;18:120–134
  16. Jobe FW, Stark H, Lombardo SJ. Reconstruction of the ulnar collateral ligament in athletes. J Bone Joint Surg Am. 1986;68:1158–1163
  17. Josefsson PO, Danielsson LG. Epicondylar elbow fracture in children. 35-year follow-up of 56 unreduced cases. Acta Orthop Scand. 1986;57:313–315
  18. Kobayashi Y, Oka Y, Ikeda M, Munesada S. Avulsion fracture of the medial and lateral epicondyles of the humerus. J Shoulder Elbow Surg. 2000;9:59–64
  19. Larson RL, Singer KM, Bergstrom R, Thomas S. Little League survey: the Eugene study. Am J Sports Med. 1976;4:201–209
  20. Lee HH, Shen HC, Chang JH, Lee CH, Wu SS. Operative treatment of displaced medial epicondyle fractures in children and adolescents. J Shoulder Elbow Surg. 2005;14:178–185
  21. Louahem DM, Bourelle S, Buscayret F, Mazeau P, Kelly P, Dimeglio A, et al. Displaced medial epicondyle fractures of the humerus: surgical treatment and results. A report of 139 cases. Arch Orthop Trauma Surg. 2010;130:649–655
  22. Lyman S, Fleisig GS, Andrews JR, Osinski ED. Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. Am J Sports Med. 2002;30:463–468
  23. Olsen SJ, Fleisig GS, Dun S, Loftice J, Andrews JR. Risk factors for shoulder and elbow injuries in adolescent baseball pitchers. Am J Sports Med. 2006;34:905–912
  24. Pappas N, Lawrence JT, Donegan D, Ganley T, Flynn JM. Intraobserver and interobserver agreement in the measurement of displaced humeral medial epicondyle fractures in children. J Bone Joint Surg Am. 2010;92:322–327
  25. Petty DH, Andrews JR, Fleisig GS, Cain EL. Ulnar collateral ligament reconstruction in high school baseball players: clinical results and injury risk factors. Am J Sports Med. 2004;32:1158–1164
  26. Richard MJ, Aldridge JM, Wiesler ER, Ruch DS. Traumatic valgus instability of the elbow: pathoanatomy and results of direct repair. J Bone Joint Surg Am. 2008;90:2416–2422
  27. Rohrbough JT, Altchek DW, Hyman J, Williams RJ, Botts JD. Medial collateral ligament reconstruction of the elbow using the docking technique. Am J Sports Med. 2002;30:541–548
  28. Torg JS, Pollack H, Sweterlitsch P. The effect of competitive pitching on the shoulders and elbows of preadolescent baseball players. Pediatrics. 1972;49:267–272
  29. USA Baseball Medical & Safety Advisory Committee. Youth baseball pitching injuries. November 30, 2008. http://web.usabaseball.com/. Accessed: June 1, 2010.
  30. Wells MJ, Bell GW. Concerns on Little League elbow. J Athl Train. 1995;30:249–253

PII: S1058-2746(10)00183-7

doi: 10.1016/j.jse.2010.04.038

Journal of Shoulder and Elbow Surgery
Volume 19, Issue 7 , Pages 951-957 , October 2010