Pediatric AO Surgery Reference

A major milestone in the AO Surgery Reference history has been made today as we launch the two first modules of the Pediatric AO Surgery Reference. It would have been impossible for this work to have been undertaken without the generous grant to the project from the AO Foundation Strategy Fund, to which we are extremely grateful. To access the material on iPhones, please use the latest app version.

Your AO Surgery Reference Team


Executive Editor: Chris Colton

Authors: Mariusz Bonczar, Daniel Rikli, David Ring

Distal humerus 13-A2.1/2 External fixation

back to skeleton

Glossary

Author: Dankward Höntzsch

1 Note on illustrations top

enlarge

Throughout this treatment option illustrations of generic fracture patterns are shown, as four different types:

A) Unreduced fracture
B) Reduced fracture
C) Fracture reduced and fixed provisionally
D) Fracture fixed definitively

2 Principles of modular external fixation top

enlarge

The modular external fixator is optimal for temporary use. It is rapidly applied without need for intraoperative x-rays and can be adjusted later.

Details of external fixation are described in the basic technique for application of modular external fixator.

Specific consideration for the distal humerus are given below.

3 Pin insertion (humerus/forearm) top

enlarge

Pin placement

For safe pin placement make use of the safe zones and be familiar with the anatomy of the humerus and the proximal forearm.


enlarge

Soft tissue dissection

Blunt dissection of the soft tissues and the use of small Langenbeck retractors will prevent damage to muscular, vascular and neurological structures.

Prepare a channel for insertion of the pin, using a blunt clamp down to the bone. If there is any doubt an incision should be made big enough to prove that the drill sleeve (for the humerus a must) will have direct contact with the bone.

Be especially careful of the radial nerve, which spirals around the humeral shaft and, in the distal third, it intersects the lateral intermuscular septum.

4 Frame construction / reduction and fixation (distal humerus) top

enlarge

Pearl: non-bridging fixator

If the fracture is far enough from the joint and there is good bone quality, sometimes it is possible to apply the external fixator only to the humerus, leaving the elbow joint free.

v1.0 2016-10-21