• Simple avulsion fractures, minimally displaced, can be treated nonoperatively (Bede et al., 1975).

• If the AP radiograph demonstrates a minimally displaced fracture and the lateral radiograph does not demonstrate a fat pad sign, then a simple avulsion fracture (Fig. 1) has occurred rather than a fracture associated with an elbow dislocation or subluxation.

• Some authors advocate nonoperative treatment for all medial epicondyle fractures (Farsetti et al., 2001; Josefsson and Danielsson, 1986). Nonoperative treatment usually leads to a nonunion. In the nonathlete, the nonunion is rarely symptomatic. However, in athletes who are involved in overhead activities, the nonunion can result in valgus instability of the elbow and limit the athlete’s performance (Gilchrist and McKee, 2002; Sugita et al., 1994; Takeishi et al., 2001; Woods and Tullos, 1977).

• Some authors suggest that opening of the medial joint by the valgus stress test is an indication for open reduction and internal fixation. Other authors discount this test and state that all patients with significant displacement of the epicondyle will demonstrate a positive valgus stress test. Instead, the decision to operate should be based on the patient’s need to have a stable elbow for his or her sport or work (Wilkins, 1991).

• Nonoperative treatment is acceptable for some nonathletes. For these patients, treatment can include a brief period of splinting followed by range-of-motion exercises. Prolonged casting is not recommended. Many medial epicondyle fractures occur with an elbow dislocation or subluxation. Casting may lead to permanent elbow stiffness (Linscheid and Wheeler, 1965; Ross et al., 1999).

• Other techniques for fixation exist for operative treatment, such as a Kirshner wire (K-wire) rather than a screw and washer (Hines et al., 1987). However, the K-wire does not produce compression of the fracture. In addition, the less rigid and often prominent K-wire can inhibit the ability of the athlete to perform early motion. Early motion is necessary to prevent permanent elbow stiffness.