![]() ![]() For proximal ulna fractures, extended access may be needed to address radial head or coronoid fractures. Surgical repair involves a posterior approach with the incision curved radially around the olecranon process to avoid painful scarring on the point of the elbow. The incision is curved radially to avoid the point of the elbow. Note the plastic bag which allows for sterility of the hand and acts as a receptacle for irrigation fluid and any dropped instruments. Patient in lateral position with arm flexed over a post. A tourniquet applied to the upper arm is usually out of the surgical field however, a sterile one may be used based on surgeon preference. I personally prefer the lateral position which allows easy access to the proximal ulna and extension to medial or lateral side as needed (Figure 4). The position used is dependent on various factors including surgeon experience presence of other injuries precluding certain positions, for example a spine injury may necessitate prone or supine position the need for other concurrent surgeries like bilateral elbow fractures or acetabulum fractures may be performed in the prone position. The patient can be positioned supine with the arm across the chest lateral or prone with the elbow flexed over a padded post. This technique aids in the reduction while supplementing fixation strength.Įxcision of smaller fragments (up to 40%) with tendon advancement is reserved for patients with limited function and may have little or no advantage over non-operative care. Note the use of additional mini-fragment plates to allow fixation of smaller fragments not captured by the larger plate. Proximal ulna fracture fixed using a pre-contoured locking plate with radial head replacement. Reconstruction type plates may also be used and contoured by the surgeon to fix the proximal ulna (Figure 3). Newer implants include olecranon nail which can be used for simpler fracture patterns as well.įor proximal ulna fractures, use of stronger implants, like commercially available pre-contoured plates with a proximal curve that goes around the olecranon and allows for increased proximal fixation are recommended to minimize chances of failure. ![]() This is amenable for simpler fractures patterns of the olecranon and not recommended for proximal ulna higher energy fractures. Olecranon fracture fixed with a hook plate, a one-third tubular plate contoured to the bone and fixed with small fragment screws. Plating is best indicated for comminuted or oblique fracture patterns the plate can be a one third tubular plate for simple fracture patterns (Figure 2) or a reconstruction type plate or pre-contoured locking plate for comminuted ones. Tension Band wiring for olecranon fracture. An intramedullary screw (6.5 or 7.3mm cancellous screw) may also be used in lieu of K-wires and is biomechanically superior, but screw head prominence may be an issue. Tension band wiring using two parallel K-wires and circlage or figure of eight wires (or sutures) passed through a bone tunnel distally is indicated for simple transverse intra-articular fractures and avulsion fractures (Figure 1). Proximal ulna or olecranon fractures associated with elbow instability and/or radial head or coronoid fractures which may require fixation. Loss of active elbow extension (as tested with gravity eliminated) implying loss of extensor mechanism. Non-operative treatment is indicated for non-displaced or minimally displaced (2mm. If the elbow is dislocated, as may happen with high energy proximal ulna fractures, a closed reduction should be performed and the elbow splinted prior to further radiographic workup. A CT scan is recommended for complex fractures to delineate the presence of a coronoid fracture or radial head fracture morphology to assist in treatment planning. Radiographs include an Antero-Posterior view lateral view and oblique views if the radial head fracture is suspected. Distal neuro-vascular checks are important with higher energy injuries, with attention to ulnar and posterior interosseous nerves. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |