Valgus instability of the elbow due to medial epicondyle nonunion: treatment by fragment excision and ligament repair--a report of 5 cases.

We identified 5 patients with valgus instability of the elbow due to nonunion of a previous fracture of the medial epicondyle. There were 4 male patients and 1 female patient with a mean age of 35 years (range, 15-54 years). The original avulsion fracture of the medial epicondyle had occurred a mean of 10.1 years previously (range, 4 months to 25 years), and all patients had had their initial fracture treated nonoperatively. After the development of medial epicondyle nonunion, 3 patients had been treated nonoperatively and 2 had undergone unsuccessful attempts at osteosynthesis. All patients were treated with excision of the medial epicondyle, advancement of the medial collateral ligament, and fixation to the distal humerus with suture anchors. The mean Mayo Elbow Performance Score improved from 66 preoperatively to 91 postoperatively (P <.05), and all patients were satisfied with the increased stability provided by the procedure. On the basis of our experience with these 5 patients, it appears that excision of the nonunion fragment and repair of the medial collateral ligament to the distal humerus can provide satisfactory outcomes in these patients.