Ortho Michigan, Hurley Medical Center, Flint, MI.
Banner University Medical Center, University of Arizona, Tuscon AZ.
J Orthop Trauma. 2019 Aug;33 Suppl 1:S9-S10. doi: 10.1097/BOT.0000000000001530.
The purpose of this video is to present a technique for open reduction and internal fixation of a displaced unstable medial epicondyle avulsion fracture.
A 13-year-old boy presented 2 days after injury at our institution after sustaining a medial epicondyle avulsion fracture with incarcerated fragment and posterolateral dislocation of the elbow after a fall off a fence. He described paresthesia in the ulnar nerve distribution and demonstrated slight weakness to intrinsic hand strength on examination. He was urgently reduced under sedation in the emergency department using the Roberts maneuver, a technique consisting of a valgus stress with forearm supination with finger and wrist extension that uses muscle forces to extract the fragment. Successful reduction of the ulna-humeral joint and extraction of the incarcerated medial epicondyle was demonstrated on CT. The patient was then taken in a nonurgent fashion to the operating room for open reduction and internal fixation of the displaced medial epicondyle fracture. Intraoperative examination after fixation demonstrated a congruent and stable elbow. A long-arm cast was then applied.
The video is 7-minute, 38-second duration in time and 461 MB in size.
Although fixation of medial epicondyle avulsion fractures may be controversial, there are some indications for ORIF including incarcerated epicondylar fragment, suspected entrapment and dysfunction of the ulnar nerve, marked instability of the elbow, and open fracture. Presented in this video is a safe technique for ORIF of the displaced and unstable medial epicondyle avulsion fracture.
本视频旨在介绍一种治疗移位不稳定内侧上髁撕脱骨折的切开复位内固定技术。
一名 13 岁男孩因从篱笆上摔下后出现肘部内侧上髁撕脱骨折伴嵌顿块和后外侧脱位，于受伤后 2 天到我院就诊。他描述了尺神经分布区的感觉异常，并在检查时表现出轻微的手部内在力量减弱。他在急诊科通过镇静下使用 Roberts 手法紧急复位，该技术包括在旋前时施加外翻应力，同时手指和腕部伸展，利用肌肉力量将骨折块取出。CT 显示尺肱关节成功复位，嵌顿的内侧上髁被取出。然后患者以非紧急方式送往手术室，对移位的内侧上髁骨折进行切开复位内固定。固定后的术中检查显示肘关节吻合且稳定。然后应用长臂石膏固定。
视频时长 7 分 38 秒，大小为 461MB。
尽管内侧上髁撕脱骨折的固定可能存在争议，但对于一些情况，如嵌顿的上髁骨块、尺神经可疑受压和功能障碍、肘部明显不稳定、开放性骨折，ORIF 是有适应证的。本视频介绍了一种治疗移位不稳定的内侧上髁撕脱骨折的安全切开复位内固定技术。
