Medial epicondyle fractures in children: clinical decision making in the face of uncertainty.

Displaced medial epicondyle fractures are common injuries encountered in pediatric orthopaedic practice. Many practitioners have successful personal experience treating these fractures through nonoperative and operative techniques. This article discusses evidence-based medicine principles related to medial epicondyle fractures. There is a dearth of high-level evidence, and yet we are constantly faced with the need for clinical decision making in the face of uncertainty. Although highly susceptible to bias, pertinent background information (current pediatric fracture textbooks) and meta-analysis of clinical research with a particular focus on harm (and number needed to harm) support surgical recommendations for most patients.