Medial Epicondyle Fracture Distal Humerus Fracture

Daniel J. Hedequist, MD

Open Reduction Internal Fixation

Equipment

A small fragment set
3.5, 4.0 (most common), or 4.5 mm cannulated screws
Dental pick
Smooth wires
Power drill
Fluoroscopy

Figure 7-1 ▪ Displaced medial epicondylar humerus fracture entrapped in joint and AP and lateral X-ray views.

Figure 7-2 ▪ A prone positioning with arm on fluoroscopic table for open reduction internal fixation of medial epicondyle fracture.

Figure 7-3 ▪ After sterile prepping and draping, incision is marked on the medial side with enough length to protect ulnar nerve, reduce, and fix fracture.

Patient Positioning

Prone with arm overhanging, arm rest, or on hand table (Figure 7-2)
Alternatively
- Lateral or supine (requires a mobile glenohumeral joint into full external rotation)
C-arm from the head of table

Surgical Approaches

Medial approach incision
Curve incision just anterior to the medial epicondyle. Avoid going too anterior (Figure 7-3)
Fasciocutaneous flaps elevated with care taken to identify medial brachial and antebrachial cutaneous nerves
Identify the ulnar nerve (easiest to identify proximally) and be certain it is not entrapped (Figure 7-4)
Often the dissection into fracture site and joint is easy with blunt finger or instrument due to soft tissue disruption from associated elbow dislocation (Figure 7-5)
Inspect and mobilize fracture fragment with attached flexor-pronator origin and often attached medial periosteum and elbow ulnar collateral ligament (Figure 7-6).
Hinge open joint to inspect articular surfaces looking for additional osteochondral injuries that may require repair or removal