Study Summary

334 pediatric patients with displaced medial epicondyle fractures were randomized to receive surgical fracture fixation (n=168) or non-operative management (n=166). The primary outcome of interest was upper limb function at 12 months, measured using the Patient Report Outcomes Measurement System (PROMIS) Upper Extremity Score for Children. Additional outcomes of interest included pain, quality of life, disability, and complications. At 12 months, there were no significant differences in the primary outcome of upper limb function, as well as all secondary outcomes, suggesting no difference in clinical outcomes between the two groups. Cost-effectiveness analyses found surgery to be significantly more expensive (£2,435 [95% CI 1,812-3,057]), with 0% probability of being cost-effective at standard willingness-to-pay thresholds. Overall, the results of this randomized trial suggest that surgical intervention offers no clinical advantages over non-operative treatment and costs substantially more, thus making non-operative treatment the most reasonable treatment option.