Open Reduction Internal Fixation of a Medial Epicondyle Avulsion Fracture With Incarcerated Fragment.

Abstract

The purpose of this video is to present a technique for open reduction and internal fixation of a displaced unstable medial epicondyle avulsion fracture. A 13-year-old boy presented 2 days after injury at our institution after sustaining a medial epicondyle avulsion fracture with incarcerated fragment and posterolateral dislocation of the elbow after a fall off a fence. He described paresthesia in the ulnar nerve distribution and demonstrated slight weakness to intrinsic hand strength on examination. He was urgently reduced under sedation in the emergency department using the Roberts maneuver, a technique consisting of a valgus stress with forearm supination with finger and wrist extension that uses muscle forces to extract the fragment. Successful reduction of the ulna-humeral joint and extraction of the incarcerated medial epicondyle was demonstrated on CT. The patient was then taken in a nonurgent fashion to the operating room for open reduction and internal fixation of the displaced medial epicondyle fracture. Intraoperative examination after fixation demonstrated a congruent and stable elbow. A long-arm cast was then applied. The video is 7-minute, 38-second duration in time and 461 MB in size. Although fixation of medial epicondyle avulsion fractures may be controversial, there are some indications for ORIF including incarcerated epicondylar fragment, suspected entrapment and dysfunction of the ulnar nerve, marked instability of the elbow, and open fracture. Presented in this video is a safe technique for ORIF of the displaced and unstable medial epicondyle avulsion fracture.