Table of Contents
MECHANISM OF INJURY
This is due to indirect injury after a fall on an outstretched hand with the forearm in valgus position. The medial epicondyle is avulsed.
NATURE OF FRACTURE
This may suffer either minimal or gross displacement. In a serious condition, the medial ligament can be ruptured and the elbow- joint is dislocated. In many cases, spontaneous reduction of dislocation takes place with the epicondyle being trapped inside the joint- cavity. In all cases, the fragments tend to displace downwards due to the pull of the flexor muscles of the wrist.
The normal elbow may have to be x-rayed for comparison in many cases.
Undisplaced fracture: The condition requires simple immobilization with the forearm in the supinated position.
Displaced fracture: Manipulation is performed with the forearm positioned in such a way that the flexor muscles of the wrist are in a relaxing state. This helps the epicondyle to retrace back into its normal position.
The technique of reduction: With the forearm pronated and the wrist in a flexed position the fragment is pushed upwards. The elbow- joint is flexed while pressure on the epicondyle is maintained.
When the fragment is displaced inside the joint: The reduction may be difficult by the closed technique. The attempt is made to widen the medial side of the elbow- joint space by abducting the supinated forearm. During this stage, the fragment is pushed to return to its normal position.
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Plaster immobilization: The elbow- joint is immobilized with the joint flexed at 90⁰ and the forearm in the supinated position.
Operative Reduction: Operative reduction and fixation of the fragment by wire are needed in the case of failure to reduce by conservative means. The ulnar nerve is transposed anterior to the epicondyle, when this is found to be pushed inside the joint- cavity. Anterior transposition of the nerve is also done when there is likelihood of developing rough and irregular groove behind the epicondyle. This is done to prevent the development of friction neuritis.
FRACTURE OF THE CAPITELLUM MECHANISM OF INJURY
Fracture of the capitellum takes place due to indirect violence. The patient falls on an outstretched hand with the elbow in varus position. The head of the radius strikes against the capitellum producing fracture. The lesion may either be of displaced or undisplaced variety.
x-ray should confirm the type of fracture, the amount of separation and any shadow of separated flakes of cartilage.
Displaced fracture must be reduced.
- Closed Reduction: Traction and counter- traction are applied on the elbow-joint. Attempt is made to adduct the forearm. Downward pressure is exerted over he detached capitellum to put it into its normal position. Once the reduction is completed, the elbow-joint is gently flexed.
Immobilization: Plaster immobilization is maintained with the elbow flexed at 90⁰ for 4-6 weeks. Graduated exercise of the elbow is instituted at the end of this period.
- Operative Reduction: Operative reduction is done in case of failure of closed reduction. The detached capitellum is placed in the normal position and sutured by catgut. Any detatched flakes of cartilage inside the joint should be removed. If the capitellum is found dead during operation, it is removed. This does not produce any disability. Close contact of the radius and humerus is not essential for the normal function of the joint. The operation is performed by the specialized orthopedic surgeons who use orthopedic products in the surgical procedure which are obtained from the orthopedic implant exporters.