Andrew Howard, Theddy Slongo
The main goals for treatment (nonoperative or operative) of these ligament injuries are:
The main principles of treatment for these displaced injuries are:
Note: The lateral humeral epicondyle is intracapsular.
A double-tipped K-wire of appropriate size (1.0-1.25 mm), depending on the size of the fragment.
General anesthesia is recommended and a sterile tourniquet should be available.
The patient is placed supine with the arm draped up to the shoulder.
See also the additional material on preoperative preparation.
A standard lateral approach to the elbow is used.
As the lateral epicondyle is visualized the following can be seen:
Note: In these illustrations, the extensor muscle group is represented by only one muscle.
The avulsed ligament and bony fragment are orientated to provide a direct view of the fracture surface.
One or two retrograde double ended K-wires are passed through the fragment, from inside out, as illustrated.
The fragment is then reduced under direct vision and the wire(s) advanced, avoiding the olecranon fossa and the physis.
The wire is bent over, cut, and embedded using a punch.
Note: A cast with the forearm in either neutral or supinated position is required to prevent secondary displacement.
Note: In any case of elbow immobilization by plaster cast, careful observation of the neurovascular situation is essential both in the hospital and at home.
See also the additional material on postoperative infection.
It is important to provide parents/carers with the following additional information:
If the child remains for some hours/days in bed, the elbow should be elevated on pillows to reduce swelling and pain.
The postoperative protocol is as follows: