AT: The Bony Tommy John Injury – Medial Epicondyle Fractures in Throwing Athletes

The optimal method of treatment for medial humeral epicondyle fractures in pediatric patients is still controversial. This injury can occur due to excessive valgus stress placed on the elbow by the pronator muscle mass that have a common point of origin at the medial epicondyle. In throwing athletes such as baseball pitchers this can occur during a pitch. Non-operative as well as operative management have been reported to have positive outcomes and lack consensus about when either is indicated. This disparity is the root of the controversy. The only consensus for operative intervention exists when there is incarceration of the fracture fragment in the joint space, ulnar nerve involvement or dislocation. This report outlines the injury of a 15-year-old baseball player who injured his elbow while pitching. His physical examination and x-rays confirmed a right-sided medial humeral epicondyle fracture and treatment options were discussed. With the intention of a speedy return to baseball and normal function, the patient and his family opted for open reduction and internal fixation (ORIF).