Basic treatment techniques |
Basic technique: Modular external fixation |
Surgical procedures sorted by fracture typeUse this menu to jump directly into a specific classification (optional): |
A1.1 A1.2 A1.3 A2.1 A2.2 A2.3 A3.1 A3.2/3 B1 B2 B3.1 B3.2 B3.3 C1 C2.1 C2.2/3 C3 |
A1.1
Extraarticular fracture of the ulna, avulsion of the triceps insertionPlease select a treatment option: |
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Treatment | Indication summary | Skill | Equipment |
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Circular cast or splint | Minimal displacement (< 2 mm). Active elbow extension. Immobilization desired. | ![]() |
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Functional treatment | Minimal displacement (< 2 mm). Active elbow extension. Immobilization unnecessary. | ![]() |
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Triceps reinsertion | Small and/or multiple fragment(s). Osteoporotic bone. | ![]() |
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A1.2
Extraarticular fracture of the ulna, simple metaphysealPlease select a treatment option: |
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Treatment | Indication summary | Skill | Equipment |
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Circular cast or splint | Undisplaced, stable fracture. | ![]() |
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Temporary external fixation | Instability that can not be controlled with splint or cast. Significant soft-tissue injury or contamination. | ![]() |
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Compression plate | Transverse fracture. | ![]() |
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Compression plate and lag screw | Oblique fracture suitable for compression with both lag screw and plate. | ![]() |
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Lag screw and protection plate | Oblique fracture. Interfragmentary compression by lag screw, but not plate. | ![]() |
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A1.3
Extraarticular fracture of the ulna, multifragmentary metaphysealPlease select a treatment option: |
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Treatment | Indication summary | Skill | Equipment |
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Circular cast or splint | Undisplaced, stable fracture. | ![]() |
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Temporary external fixation | Instability that can not be controlled with splint or cast. Significant soft-tissue injury or contamination. | ![]() |
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Bridging plate | Unstable, displaced fracture. Instability of radiocapitellar or proximal radioulnar joint. | ![]() |
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A2.1
Extraarticular fracture of the radius, avulsion of bicipital tuberosityPlease select a treatment option: |
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Treatment | Indication summary | Skill | Equipment |
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Functional treatment | Excessive surgical risk. Low demand, elderly patient. | ![]() |
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Biceps reinsertion | Loss of flexion and supination strength. | ![]() |
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A2.2
Extraarticular fracture of the radius, simple radial neckPlease select a treatment option: |
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Treatment | Indication summary | Skill | Equipment |
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Circular cast or splint | Undisplaced stable fracture. Immobilization desired. | ![]() |
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Functional treatment | Undisplaced fracture. >70% supination and pronation. | ![]() |
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Lag screw fixation | Oblique fracture. | ![]() |
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Compression with T-plate | Displaced transverse fracture. | ![]() |
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A2.3
Extraarticular fracture of the radius, multifragmentary radial neck fracturePlease select a treatment option: |
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Treatment | Indication summary | Skill | Equipment |
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Circular cast or splint | Undisplaced fracture. | ![]() |
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Temporary external fixation | Extensive soft-tissue damage. Severe contamination. Infection. Major bone loss. | ![]() |
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Bridging plate (multifragmentary fracture) | Displaced or unstable fracture. Stable fixation possible. | ![]() |
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Replacement arthroplasty | Unstable elbow joint. Associated interosseous membrane injury (Essex-Lopresti injury). | ![]() |
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A3.1
Extraarticular fracture of both bones, simplePlease select a treatment option: |
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Treatment | Indication summary | Skill | Equipment |
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Temporary external fixation | Instability that can not be controlled with cast or splint. Extensive soft-tissue damage. Severe contamination. Infection. Major bone loss. | ![]() |
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Compression plate for ulna | Transverse fracture. | ![]() |
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Compression plate and lag screw for ulna | Fracture suitable for compression with both plate and lag screw. | ![]() |
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Lag screw and protection plate for ulna | Fracture suitable for compression with lag screw but not plate. | ![]() |
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Lag screw fixation for radius | Oblique fracture. | ![]() |
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Compression with T-Plate for radius | Transverse fracture. | ![]() |
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A3.2/3
Extraarticular fracture of both bones, one or both multifragmentaryPlease select a treatment option: |
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Treatment | Indication summary | Skill | Equipment |
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Temporary external fixation | Joint instability. Extensive soft-tissue damage. Severe contamination. Infection. Major bone loss. | ![]() |
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Compression plate for ulna | Transverse fracture. | ![]() |
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Compression plate and lag screw for ulna | Fracture suitable for compression with both plate and lag screw. | ![]() |
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Lag screw and protection plate for ulna | Fracture suitable for compression with lag screw but not plate. | ![]() |
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Bridging plate for ulna | Multifragmentary fracture. | ![]() |
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Lag screw fixation for radius | Oblique fracture. | ![]() |
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Compression with T-plate for radius | Transverse fracture. | ![]() |
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Bridging plate for radius | Multifragmentary fracture. | ![]() |
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Replacement arthroplasty for radius | Unstable elbow joint. Inability to fix the radial neck satisfactorily. | ![]() |
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B1
Articular fracture of the ulnaPlease select a treatment option: |
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Treatment | Indication summary | Skill | Equipment |
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Circular cast or splint | Undisplaced B1.1 fracture. Immobilization desired. | ![]() |
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Temporary external fixation | Joint instability. Extensive soft-tissue damage. Severe contamination. Infection. Major bone loss. | ![]() |
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Hinged external fixation following ORIF | Persistent elbow instability. Protection for weak fixation. Motion desired. | ![]() |
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Tension band wiring | Transverse simple fracture of the olecranon. | ![]() |
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Lag screw and protection plate | Oblique fracture of the olecranon. | ![]() |
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Tension band plate | Unifocal, transverse olecranon fracture, or minimally comminuted but with similar stability. | ![]() |
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Bridging plate | Multifragmentary fractures. | ![]() |
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Repair of coronoidal fracture | Coronoidal fracture with elbow instability. | ![]() |
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B2
Articular fracture of the radiusPlease select a treatment option: |
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Treatment | Indication summary | Skill | Equipment |
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Circular cast or splint | Undisplaced or minimally displaced fractures with acceptable supination and pronation range. Immobilization desired. | ![]() |
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Functional treatment | Undisplaced or minimally displaced fractures with acceptable supination and pronation range. | ![]() |
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Temporary external fixation | Joint instability. Extensive soft-tissue damage. | ![]() |
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Lag screw fixation | Simple displaced fractures. | ![]() |
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Lag screws through plate | Reconstructible multifragmentary fracture. Fracture where lag screws alone provide inadequate stability. | ![]() |
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Excision of the radial head | Isolated unreconstructable radial head fracture with stable elbow. Intact interosseous membrane and distal radioulnar joint (DRUJ). | ![]() |
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Replacement arthroplasty | Inability to reconstruct radial head fracture so that it provides sufficient stability for elbow joint. Interosseous membrane injury (Essex-Lopresti injury). | ![]() |
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B3.1
Simple articular ulna, extraarticular radiusPlease select a treatment option: |
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Treatment | Indication summary | Skill | Equipment |
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Temporary external fixation | Joint instability. Extensive soft-tissue damage. Severe contamination. Infection. | ![]() |
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Hinged external fixation following ORIF | Persistent elbow instability. Protection for weak fixation. Motion desired. | ![]() |
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Tension band wiring for olecranon | Transverse simple fracture. No instability of radial fracture. | ![]() |
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Lag screw and protection plate for olecranon | Oblique fracture. | ![]() |
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Tension band plate for olecranon | Unifocal, transverse olecranon fracture, or minimally comminuted but with similar stability. | ![]() |
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Lag screw fixation for radius | Oblique fracture. | ![]() |
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Compression with T-plate for radius | Transverse fracture. | ![]() |
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Bridging plate (simple, impacted fracture) for radius | Shortened radial neck fracture with loss of bone volume (impaction). | ![]() |
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Bridging plate (multifragmentary fracture) for radius | Multifragmentary fracture with shortening. | ![]() |
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Replacement arthroplasty for radius | Inability to reconstruct radial head or neck fracture so that it provides sufficient stability for elbow joint. Interosseous membrane injury (Essex-Lopresti injury). | ![]() |
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B3.2
Simple articular radius, extraarticular ulnaPlease select a treatment option: |
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Treatment | Indication summary | Skill | Equipment |
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Temporary external fixation | Joint instability. Extensive soft-tissue damage. Severe contamination. Infection. | ![]() |
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Lag screw fixation for radius | Simple fracture of the radial head. | ![]() |
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Compression plate for ulna | Transverse fracture. | ![]() |
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Compression plate and lag screw for ulna | Simple oblique fracture, suitable for compression with both lag screw and plate. | ![]() |
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Lag screw and protection plate for ulna | Fracture suitable for compression with lag screw but not plate. | ![]() |
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Bridging plate for ulna | Multifragmentary fracture. | ![]() |
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B3.3
Multifragmentary articular of one bone, extraarticular of the otherPlease select a treatment option: |
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Treatment | Indication summary | Skill | Equipment |
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Temporary external fixation | Joint instability. Extensive soft-tissue damage. Severe contamination. Infection. | ![]() |
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Hinged external fixation following ORIF | Persistent elbow instability. Protection for weak fixation. Motion desired. | ![]() |
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Bridging plate for olecranon | Multifragmentary fracture. | ![]() |
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Repair of coronoidal fracture | Coronoidal fracture with elbow instability. | ![]() |
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Lag screws and plate for radius | Reconstructible multifragmentary fracture of the radial head/neck. Fracture where lag screws alone provide inadequate stability. | ![]() |
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Replacement arthroplasty for radius | Unreconstructable fracture of the radial head or neck. | ![]() |
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Compression plate for ulna | Transverse fracture. | ![]() |
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Compression plate and lag screw for ulna | Oblique fracture, suitable for compression with both plate and lag screw. | ![]() |
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Lag screw and protection plate for ulna | Fracture suitable for compression with lag screw but not plate. | ![]() |
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Bridging plate for ulna | Multifragmentary extraarticular fracture. | ![]() |
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Lag screw fixation for radius | Oblique fracture. | ![]() |
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Compression with T-plate for radius | Transverse fracture. | ![]() |
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Bridging plate (simple, impacted fracture) for radius | Shortened radial neck fracture with loss of bone volume (impaction). | ![]() |
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Bridging plate (multifragmentary fracture) for radius | Multifragmentary fracture with shortening. | ![]() |
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C1
Simple articular fractures of both bonesPlease select a treatment option: |
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Treatment | Indication summary | Skill | Equipment |
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Temporary external fixation | Joint instability. Extensive soft-tissue damage. Severe contamination. Infection. | ![]() |
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Hinged external fixation following ORIF | Persistent elbow instability. Protection for weak fixation. Motion desired. | ![]() |
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Lag screw and protection plate for olecranon | Oblique fracture. | ![]() |
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Tension band plate for olecranon | Unifocal, transverse olecranon fracture, with restored stability or radial head fracture. | ![]() |
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Repair of coronoidal fracture | Coronoidal fracture with elbow instability. | ![]() |
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Lag screw fixation of radial head | Single-fragment radial head fracture. | ![]() |
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C2.1
Articular fracture of both bones, Olecranon multifragmentary, radial head simplePlease select a treatment option: |
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Treatment | Indication summary | Skill | Equipment |
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Temporary external fixation | Joint instability. Extensive soft-tissue damage. Severe contamination. Infection. | ![]() |
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Hinged external fixation following ORIF | Persistent elbow instability. Protection for weak fixation. Motion desired. | ![]() |
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Bridging plate for olecranon | Multifragmentary fracture. | ![]() |
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Repair of coronoidal fracture | Coronoidal fracture with elbow instability. | ![]() |
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Lag screw fixation of radial head | Simple fracture. | ![]() |
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C2.2/3
Articular fracture of both bones, olecranon or coronoid simple, radial head multifragmentaryPlease select a treatment option: |
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Treatment | Indication summary | Skill | Equipment |
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Temporary external fixation | Joint instability. Extensive soft-tissue damage. Severe contamination. Infection. | ![]() |
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Hinged external fixation following ORIF | Persistent elbow instability. Protection for weak fixation. Motion desired. | ![]() |
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Lag screw and protection plate for olecranon | Oblique fracture. | ![]() |
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Tension band plate for olecranon | Unifocal, transverse olecranon fracture, with restored stability or radial head fracture. | ![]() |
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Repair of coronoidal fracture | Coronoidal fracture with elbow instability. | ![]() |
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Lag screws and plate for radius | Reconstructible multifragmentary fracture of the radial head. | ![]() |
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Replacement arthroplasty for radius | Unreconstructable fracture of the radial head. | ![]() |
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C3
Multifragmentary articular fractures of both bonesPlease select a treatment option: |
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Treatment | Indication summary | Skill | Equipment |
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Temporary external fixation | Joint instability. Extensive soft-tissue damage. Severe contamination. Infection. | ![]() |
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Hinged external fixation following ORIF | Persistent elbow instability. Protection for weak fixation. Motion desired. | ![]() |
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Bridging plate for olecranon | Multifragmentary fractures. | ![]() |
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Repair of coronoidal fracture | Coronoidal fracture with elbow instability. | ![]() |
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Lag screws and plate for radius | Reconstructible multifragmentary fracture of the radial head. | ![]() |
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Replacement arthroplasty for radius | Unreconstructable fracture of the radial head. | ![]() |
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Special considerations |
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Principles of management of open fractures | |||
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*Skill | |
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Basic surgical experience, no specialized skills |
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Some specialized surgical experience |
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Highly experienced and skilled surgeon |
*Equipment | |
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Basic equipment only |
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Simple surgical and imaging resources |
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Full specialized surgical and imaging resources |