- See:
Medial Approach:
- Discussion:
- medial epicondyle is common origin of several
flexor muscles of
hand and wrist;
- when medial epicondyle is frxed, flexor muscles pull fragment distally;
- during surgical procedure care must be made to protect
ulnar nerve;
- Fixation Stratedgy:
- medially directed plate fixation takes advantage of avoiding ulnar nerve,
except when the distal plate screw extends over the distal-medial
portion of the condyle;
-
w/ low medial column frx, a
1/3 tubular plate may be contoured around the
medial condyle, which allows insertion of a interfragmentary lag screw,
directed superiorly in the medial column (avoid the fossa);
- as mentioned, a plate placed over the distal-medial edge of the condyle
will encroach on the
cubital tunnel and may irritate the
ulnar nerve;
- in these patients,
anterior transposition may indicated;
- implants:
-
4.0 cancellous bone screws, 3.5 mm cortex screws, or 4.5 mm canulated
screws as lag screws;
-
one third tubular plate may be necessary for larger fragments;
- technique:
- contour a
3.5-millimeter reconstruction plates to the medial epicondyle;
- the reconstruction plate is contoured and bent around to cradle the epicondyle;
- most distal screws are directed into medial epicondyle;
-
ulnar nerve in condylar fractures:
- note that a plate or lag screw placed over the distal-medial edge of the condyle
will encroach on the
cubital tunnel and may irritate the
ulnar nerve;
- in these patients,
anterior transposition may indicated;
Fracture of the medial condyle of the humerus.
