- Discussion:
- if the frx needs a reduction, then the frx is not a type I but a type II;
- posterior cortex remains intact, making it a greenstick frx;
- technically a type II frx implies posterior displacement, but frequently
there will also be medial impaction w/ varus angulation, and hence
there will be an need for
reduction and
percutaneous pinning inorder
to avoid
cubitus varus;
- Radiographs:
- conisder the need for contralateral elbow radiographs to help determine
normal anatomy;
- Treatment:
- these frx require adequate
reduction for acceptable alignment;
- requires use of GEA;
- involves correction of angulation in the frontal and saggital planes;
- reduction involves elbow pronation and flexion;
- arm is immobilized in pronation and an appropriate amount of flexion
which should not exceed 120 deg;
-
percutaneous pinning is being used more liberally than in the past;
- chief indication for pinning is fracture which requires excessive elbow
flexion for maintenance of reduction;
- relative indication is excessive arm swelling which may interfere
w/ maintenance of reduction;
- because type II frx have an intact posterior cortex (w/ enhanced stability)
consider use of 2 lateral pins (as opposed to medial and lateral pins);
- w/ 2 lateral pins, there is no risk to the ulnar nerve;
- pins may be parallel or crossed proximal to the frx site;
