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The Elbow More On The Elbow And The Arm
Operative Report

PREOPERATIVE DIAGNOSIS: Comminuted T-condylar fracture, right elbow.

POSTOPERATIVE DIAGNOSIS: Comminuted T-condylar fracture, right elbow.

PROCEDURE: Open reduction/internal fixation, right elbow.

SURGICAL PROCEDURE: After suitable preop medication was given on the floor, the patient was brought to the Operating Suite, placed on the operating table in a supine position. After suitable endotracheal anesthesia had been administered, the patient was turned to the prone position, with the arm hanging off the armboard. The arm was prepped with DuraPrep and draped in a normal sterile manner.

A posterior incision was made. Sharp dissection was carried through the skin and subcutaneous tissues. A Campbell-type approach was made to the posterior aspect of the distal humerus. A retrograde triceps flap was formed and pulled back down over the olecranon, exposing the fracture site. There was a lot more comminution apparent than was seen on x-ray. The radiolateral side of the joint was in at least six different pieces. There was one large piece, but most of the posterior and central portion of the lateral condyle was in just small cornflake-type pieces with no blood supply and had to be removed. On the medial side, there was one fairly large piece. I attempted to fix this with a more rigid internal fixation; but because of the almost complete loss of the lateral column and the severe intra-articular injury, it was obvious that this man's elbow was doomed. I put in one screw from medial to lateral. It should be noted that the ulnar nerve was identified early in the case, and was carefully protected. The screw was placed from medial to lateral and K-wires from lateral to medial. I checked the position on the C-arm, and adequate positioning was noted, with all the fragments being in good position for healing, with all the intra-articular injury and loss of articular cartilage. I believe "the die is cast" for this elbow as far as getting an excellent result.

The wound was irrigated out with antibiotic solution. The triceps flap was sutured back and the subcutaneous tissues were closed with 2-O Vicryl. The skin was closed with interrupted skin clips. Sterile dressings were applied.

The patient was awakened in the Operating Room and taken to Recovery, after a posterior splint had been applied. Patient tolerated the procedure well.

For correspondence send email to lahatte@vicksburg.com.

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