Executive Editor: Chris Colton

Authors: Mariusz Bonczar, Daniel Rikli, David Ring

Distal humerus - Extraarticular, avulsion of lateral epicondyle

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Glossary

General considerations

These fractures represent avulsions of the humeral attachment of the lateral ligament complex of the elbow. Any displacement should raise the awareness that there may be significant ligamentous varus instability: internal fixation helps to restore ligamentous integrity of the elbow.

Pediatric fractures are considered in Pediatric trauma of Surgery Reference.

Nonoperative treatment
Indication summary Skill Equipment
Minimally displaced or patient not fit for surgery Basic surgical experience, no specialized skills Basic equipment only

Indications

  • Small fragment not influencing stability
  • Minimal or no displacement

Contraindications

  • Joint instability
  • Large fragment
  • Displacement

Advantages

  • No scarring
  • Non-invasive
  • Inexpensive
  • Delayed surgery is possible

Disadvantages

  • Immobilization
  • Subsequent stiffness of the joint
  • Patient discomfort
ORIF - Screw fixation
Indication summary Skill Equipment
Any significant displacement. Incarceration in joint. Varus instability of elbow Some specialized surgical experience Simple surgical and imaging resources

Indications

  • Open fracture
  • Large (displaced) fragment
  • Joint instability

Contraindications

  • Age
  • Unacceptable surgical risk
  • Noncompliant patient

Advantages

  • Direct reduction
  • Reduced risk of stiffness
  • Restoration of joint stability
  • Early functional aftertreatment

Disadvantages

  • More invasive
  • Risk of infection
  • Often scar sensitivity
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2007-06-21