Reduction: This is done under general anesthesia by applying traction and counter-traction with the elbow in extension.
Correction of displacement: While the traction is maintained, the distal fragment is grabbed with one hand and pressed backward while the proximal segment of the humerus is pressed anteriorly.
Plaster immobilization: A dorsal slab is applied with the elbow in extension. The slab extends from the axilla up to the metacarpal heads. When swelling subsides, the plaster is completed. Immobilization is maintained for a period of 3-4 weeks. The graduated exercise of the elbow is practiced once the plaster is removed.
T AND Y- SHAPED FRACTURES:
Mechanism of injury: This is a result of direct violence. The patient strikes his flexed elbow against a hard surface. The olecranon process is thrust against the humerus. This produces T or Y- shaped fractures.
Nature of fracture: The condyles are separated by the fracture line. The amount of displacement is likely to vary from minimal to wide separation. Either of the condyles can attain a bigger size. The fracture may be comminuted.
Reduction: Proper reduction by a closed method often proves unsuccessful.
Technique: This is done under general anesthesia. While traction and counter-traction are maintained with the elbow in extension, the surgeon applies pressure on the condyles with both of his hands, trying to bring the fragment into maximum opposition.
Immobilization: Plaster immobilization is done with the elbow in 90⁰ flexion for 6 weeks.
Treatment by the simple cuff and collar sling: In elderly patients with severe comminution, treatment by simple cuff and collar sling and exercise can be advocated. This may be the choice in certain cases to avoid having a stiff joint.
Treatment by traction: Treatment by skin or skeletal traction can be effective. After manipulation under anesthesia, the traction is maintained for a period of 4 weeks. Traction can be applied either by the horizontal bedside or overhead traction. The graduated exercise of the elbow is instituted at the end of the period of immobilization.
Treatment by internal fixation: Failure to reduce by closed technique will require open reduction. The procedure may be a simple one when performed by the posterior approach. It is ideal when the condyles are separated into two pieces. Attempt to perform internal fixation in a comminuted fracture may be difficult and should be rarely attempted. Fixation is done by screw, wire or by the plate.
FRACTURE OF THE LATERAL CONDYLE:
Fracture through the lateral condyle epiphysis is a common fracture amongst the children. Improper management leads to serious disability. The result is likely to be an ulnar nerve paralysis.
MECHANISM OF INJURY:
The injury is produced by indirect violence after a fall on the hand with the elbow in an extended position. The head of the radius impinges against the capitellum producing fracture of the lateral condyle.
NATURE OF FRACTURE:
The fracture line involves the articular surface of the distal end of the humerus. The amount of distraction may vary from no displacement to complete rotation and separation of the fractured segment. Extensor muscles attached to the condyle exert traction separation. In serious injury, there may be associated dislocation of the elbow joint.
X-ray: Undisplaced fracture may be overlooked. The normal elbow should be x-rayed for comparison where difficulty is experienced between epiphysis and fracture in children.
- Undisplaced fracture: Undisplaced fracture of the lateral condyle is notorious for instability. The elbow is immobilized in plaster flexed at 90⁰. Check x-rays should be taken at intervals to see if there is any displacement of the fracture. In cases where separation is detected in the check x-ray, one must consider operative fixation of the condyle.
- Displaced fracture: Closed reduction can be successful, but many cases requires surgery. Surgeons need orthopedic implants and devices to perform the surgery which is provided top orthopaedic implant manufacturer company in India.
- Closed reduction: Under general anesthesia and with the use of muscle relaxant, an attempt to reduce the fracture is made in stages.
- Traction: Traction and counter- traction over the elbow is applied.
- Inward push of forearm: While the traction is maintained the forearm is pressed to produce various deformity of the elbow- joint. This is done by applying the palm of the surgeon over the medial side of the elbow and pressing the forearm of the patient medically. This opens the joint towards the outer side.
- Pushing the fragment into position: The elbow is slowly flexed and with the aid of the thumb the fractured lateral condyle is pushed upward towards its normal position.
- A long arm dorsal slab is applied with the elbow flexed to 90⁰. Post- reduction
- x-ray is taken. Plaster is completed when the check x-ray is satisfactory
Operative reduction: Failure to reduce the fracture by closed method needs open reduction. During the time of operation, the fractured segment will be found to be bigger than the x-ray findings.
Fracture of the lateral condyle may produce impaired growth on the outer side of the distal end of the humerus. The growth of the medial side remains unaffected. This will lead to cubitus valgus deformity. Traction neuritis and ulnar nerve palsy are the ends- products of this condition.