Executive Editor: Fergal Monsell General Editor: Chris Colton

Authors: Andrew Howard, Theddy Slongo

Pediatric distal humerus 13-E/7L

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Glossary

1 Goals and principles top

Goals

The main goals for treatment (nonoperative or operative) of these ligament injuries are:

  • Restoration of elbow stability
  • Prevention of nonunion of the epicondyle
  • Prevention of secondary displacement

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Principles

The main principles of treatment for these displaced injuries are:

  • To achieve reduction and stable fixation
  • Restoration and maintenance of elbow stability

Note: The lateral humeral epicondyle is intracapsular.

2 Preparation top

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Instruments and implants

A double-tipped K-wire of appropriate size (1.0-1.25 mm), depending on the size of the fragment.


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Anesthesia and positioning

General anesthesia is recommended and a sterile tourniquet should be available.

The patient is placed supine with the arm draped up to the shoulder.

3 Approach top

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A standard lateral approach to the elbow is used.

As the lateral epicondyle is visualized the following can be seen:

  • In younger children with an isolated cartilage avulsion, the amount of bleeding is minimal
  • In older children with a bony avulsion, bleeding is visible from the site of avulsion

Note: In these illustrations, the extensor muscle group is represented by only one muscle.

4 K-wire fixation top

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The avulsed ligament and bony fragment are orientated to provide a direct view of the fracture surface.

One or two retrograde double ended K-wires are passed through the fragment, from inside out, as illustrated.


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The fragment is then reduced under direct vision and the wire(s) advanced, avoiding the olecranon fossa and the physis.


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The wire is bent over, cut and embedded using a punch.

v1.0 2016-12-01