FRACTURES OF THE LATERAL CONDYLAR PHYSIS

REASON FOR VISIT:

• Trauma to the elbow

• Fracture of elbow

RISK ASSESSMENT

• Bleeding disorders
• Anemia
• Heart diseases
• Pulmonary insufficiency
• Allergies to medication
• Allergies to anesthesia

PREPARATION OF THE PATIENT:

• Blood tests
• Urine tests
• X-ray chest
• ECG
• X-ray distal end of humerus
• Arthrogram
• MRI
• Aspirin was stopped before procedure
• Blood thinning medication was stopped before procedure
• Patient was on fasting for _______hrs before procedure
• Part was prepared and draped in sterile fashion

ANESTHESIA:

• General anesthesia

POSITION OF THE PATIENT:

 • Supine position

THE PROCEDURE

Cast treatment:

• Non-displaced fracture was found in X-ray

• Log arm cast was prepared
• Immobilization was done with cast with elbow in 90o flexion and
forearm in pronation
• X-ray was taken

Operative Treatment:

• Posterior incision was made which curves along the medial side
of olecranon
• And proximally dissected through the brachioradialis - triceps
interval
• Ulnar Nerve was identified and protected;
• Triceps tendon was transected 1 cm from its insertion
• Remaining triceps insertion was elevated medially /laterally;
• The proximal portion of the tendon was mobilized proximally
• Posterior capsule was opened transversely from medial to lateral
• Posterior aspect of fracture fragment was left undisturbed
• Initially stabilized the fracture fragment with a towel clip;
• Stabilized the anatomic reduction with two K-wires placed
through puncture wounds in skin posterior and lateral to the
initial skin incision
• Triceps tendon was closed securely with non absorbable sutures
• Arm was immobilized in a cast

FINDINGS:

• Lateral condylar displaced/non displaced fracture was found

• Damaged ulnar nerve was found
 • Damaged brachioradialis muscle was found

AFTER PROCEDURE:

• Patient was shifted to intensive care unit

• Heart rate, pulse rate, oxygenation, temperature was monitored.

DURATION

___________hrs

POSTOPERATIVE CARE

• Put cast for 6 wks

• Take antibiotics as prescribed
• Take pain medication as prescribed
• Avoid heavy weight lifting
• Do active and passive movements after cast was removed

COMPLICATIONS

• Non union
• Delayed union
• Mal union
• Infection
• Ulnar nerve palsy
• AVN of capitellum
• Cubitus varus
• Cubitus valgus
• Deformity of elbow