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Open Reduction and Internal Fixation for Lateral Unicondylar Distal Humeral Fractures
Arvind von Keudell1, Amin Mohamadi2, Claudia A Bargon1
1Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Introduction:
Unicondylar distal humeral fractures are uncommon, partially intra-articular fractures (OTA/AO type B1) that are among the most complex fractures to treat1,2; however, most displaced distal humeral fractures, including lateral unicondylar distal humeral fractures2-5, can be effectively managed with open reduction and internal fixation.
Step 1 Preparation Of The Operating Room And The Patient:
Perform sterile preparation, have the patient brought into the operating room, induce anesthesia, and place the patient in the lateral decubitus or supine position before sterile draping.
Step 2 Approach To The Fracture:
Make a lateral incision, expose the lateral distal part of the humerus, identify the ulnar nerve if necessary, visualize the fracture fragments, and debride the fracture site.
Step 3 Reduction Of The Fracture:
Reduce the fracture and fix it temporarily.
Step 4 Plate Fixation Of The Fracture:
Determine the plate length; position the plate posterolaterally, posteriorly, or laterally; insert screws; remove provisional Kirschner wires; and obtain intraoperative images.
Step 5 Final Radiographic Imaging:
Make anteroposterior and lateral radiographic images to confirm reduction and adequate anatomic alignment of the elbow and the position of the hardware.
Step 6 Closure Of The Wound:
Deflate the tourniquet, irrigate the wound, and apply postoperative dressings.
Results:
The detailed outcome for a cohort of 24 patients who underwent this procedure has been reported elsewhere6.
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