Transcondylar screw and antirotational pin

Anatomic reconstruction of the joint surface is essential and can be achieved by reducing the fracture's epicondylar component and applying temporary transcondylar compression using bone-holding forceps.

Depending on the patient's age and bone quality, either a transcondylar lag screw or a position screw is applied. Proper alignment of the epicondyle is essential during screw insertion. An antirotational K-wire is placed to secure the epicondylar component of the fracture.

The patient is placed in dorsal recumbency.

A lateral approach to the elbow is used.

The fracture can be stabilized using either an outside-in or inside-out technique.

The fracture is manually reduced and secured using large, pointed reduction forceps. The reduction can be checked using fluoroscopy. The forceps are placed on either side of the condyle to compress the condyle's medial and lateral parts. Care should be taken to ensure that the forceps do not interfere with the placement of the transcondylar screw.

Note: Care must be taken to reduce the fracture's epicondylar portion since the reduction forceps mainly compress the fracture's condylar component, which is not visible. Perfect reduction of the epicondylar fracture ensures reduction of the condylar fracture.

Once reduced, the anatomical landmarks for screw placement are palpated.

A temporary transcondylar K-wire may be placed. The position of the K-wire can be checked using fluoroscopy.

The entry point for the transcondylar screw should be in the extensor fossa, just cranial and distal to the lateral epicondyle.

The drill should exit on the opposite side near the medial epicondyle, ideally just cranial and distal to it.

Before fracture reduction, the condylar fracture surface is exposed by cranial rotation of the fragment.

Pointed reduction forceps should be used to manipulate the fragment while taking care not to place them on the articular surface. Rotation of the fragment can be aided by flexing and extending the elbow and carpal joint during reduction.

The drill is started at the center of the fracture and aimed at the extensor fossa, which lays just cranial and distal to the lateral epicondyle.

The fracture is manually reduced and secured using an appropriately sized drill guide and large, pointed reduction forceps.

The fragment can be manipulated by placing an appropriately sized drill guide from the outside into the drill hole to help facilitate reduction. For a 3.5 mm lag screw, a 3.5/2.5 mm drill guide is inserted into the 3.5 mm hole to accept the 2.5 mm drill bit. The drill guide helps with fragment manipulation and reduction, protects the soft tissues during drilling, and centralizes the 2.5 mm drill bit in the 3.5 mm hole.

The forceps are placed on either side of the condyle to compress the condyle's medial and lateral parts.

Note: Care must be taken to reduce the fracture's epicondylar portion since the reduction forceps mainly compress the fracture's condylar component, which is not visible. Perfect reduction of the epicondylar fracture ensures reduction of the condylar fracture.

Once the fracture is perfectly reduced and secured, the drill bit is inserted and advanced into the condyle's medial part.

The drill should exit on the opposite side near the epicondyle, ideally just cranial and distal to it.

The length of the screw is determined using a depth gauge, and an appropriately sized screw is applied.

For older patients with good bone quality, a lag screw can be applied. In this case, the screw hole in the condylar fragment is overdrilled to the appropriate size for the screw.

Note: Care must be taken not to penetrate the opposite part of the condyle with the oversized drill bit.

In younger patients with soft bone, a position screw may be applied without overdrilling the hole in the condylar fragment. Alternatively, a washer can be applied under the screw head to prevent penetration of the screw into the bone.

The screw is inserted and secured but not finally tightened.

The fracture reduction and alignment are checked by confirming epicondylar fragment reduction.

An appropriately sized K-wire is inserted into the epicondyle to avoid the rotational motion of the fragment.

The K-wire is inserted caudal and proximal to the screw head to ensure parallel placement within the epicondyle. Ideally, the direction of the K-wire is parallel to and just below the lateral surface of the epicondyle.

The K-wire is advanced and should, ideally, penetrate the trans cortex of the humerus.

Note: The K-wire should not penetrate the supracondylar foramen.

The K-wire is bent and cut short, and the transcondylar screw is finally tightened.

The surgeon may remove the temporary transcondylar K-wire or leave it in place.

An 8-year-old German Spaniel was presented with a 13-B1 fracture.

The fracture was repaired using a transcondylar lag screw and an antirotational pin.

Follow-up radiographs were taken seven weeks post-operatively.

A 4-month-old Boston Terrier was presented with a 13-B1 fracture.

The fracture was fixed with a transcondylar lag screw and an antirotational pin. The transcondylar K-wire was in this case left in place.

Follow-up radiographs were taken five weeks post-operatively.

Activity restriction and controlled walking are indicated until radiographic examinations show evidence of bone healing.

The aim is to reduce edema, inflammation, and pain using anti-inflammatory and analgesic medications.

Passive range of motion exercises can help promote joint mobility.

The aim is to resolve the hematoma and edema, control pain, and prevent muscle contracture.

Anti-inflammatory and analgesic medications are still needed. Rehabilitation and integrative medical therapies can be used.

Early controlled activity and passive range of motion are strongly recommended.

A careful evaluation is recommended if the patient is not starting to use the limb within a few days after surgery.

Rehabilitation therapy is continued.

The sutures are removed 10–14 days after surgery.

A radiographic assessment is performed every 4–8 weeks until confirmed bone healing.

Implants may be removed if irritation or infection occurs. However, there is no need for implant removal if the implants are not causing problems for the patient.