Executive Editor: Chris Colton

Authors: Mariusz Bonczar, Daniel Rikli, David Ring

Distal humerus 13-A1.1 Open reduction; screw fixation

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Glossary

1 Principles top

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This is an avulsion fracture of the lateral epycondyle. By definition, there is no involvement of the joint (capitellum).
The fracture is an equivalent of an avulsion of the origin of the extensor tendons.
Typically, this injury occurs in young patients.
In order to avoid varus instability of the elbow, the fragment should be fixed.

2 Open reduction top

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Mobilize the fragment

Open the fracture site by mobilizing the fragment.

Clean out the fracture by removing blood clots and interposed tissue.


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Reduction

Reduce the fragment. Hold it temporarily in place either with a dental hook or a K-wire.

3 Fixation top

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Drilling

The fragment is fixed with a lag screw.
Usually the fragment is small and takes only 1 screw. If the fragment is large enough, you may use two screws.
Drill a 2.5 hole up to the opposite cortex. Measure for screw length, and tap the opposite cortex.
In large fragments, overdrill with a 3.5 mm drill. However, caution must be exercised so as not to break the fragment.


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Screw insertion

Insert the screw.

Occasionally, in smaller fragments, a spiked washer may be useful.

v1.0 2016-10-21