Coronoid Fx - Open Reduction Internal Fixation with Screws

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TECHNIQUE STEPS
Preoperative Patient Care
Operative Techniques
E

Preoperative Plan

1

Template Fracture

  • identify fracture pattern, displacement, comminution, and presence of dislocation

2

Execute surgical walkthrough

  • describe key steps of the operation verbally to attending prior to beginning of case.
  • description of potential complications and steps to avoid them
F

Room Preparation

1

Surgical instrumentation

  • guidewires
  • cannulated screws

2

Room setup and equipment

  • standard OR table and hand table
  • c-arm perpendicular to OR table

3

Patient positioning

  • supine position
  • place bump under ipsilateral scapula
  • place sterile tourniquet
G

Lateral Approach to the Elbow

1

Make incision along the lateral supracondylar ridge of the humerus

  • curve the incision at the lateral epicondyle toward the radial head and neck

2

Create full thickness skin flaps

  • place self retaining retractors
H

Deep Dissection

1

Expose the coronoid

  • split the common extensor tendon in line with its fibers

2

Check the LCL and common extensor tendon

  • its very common for the LCL to be avulsed from the humerus
  • check to see if the common extensor origin is avulsed
  • avulsed 2/3 of the time
I

Fracture Preparation

1

Evaluate the radial head for fracture

2

Prepare fracture

  • debride fracture site of all soft tissue to allow proper reduction
J

Fracture Reduction and Provisional Fixation

1

Pass guidewires

  • pass wires from the surface of the proximal ulna and be sure that it passes through the fracture site
  • back the guidewire until it is just buried in the proximal piece

2

Reduce fracture

3

Hold fragment reduction with a pointed instrument

  • dental pick is typically used

4

Pass guidewire across the fracture site

  • pass a second guidewire
K

Final Fixation

1

Replace the guidewires with cannulated screws

  • be sure to tap the fragment before placing screws to prevent splitting of the fragment
L

LCL Complex Repair

1

Identify origin of the LCL on the distal humerus

  • slightly posterior to the lateral condyle at the center of the arc of the capitellum

2

Repair the LCL complex

  • use no.2 braided nonabsorbable suture for the repair

3

Drill bone tunnels

4

Pass sutures through the distal humerus

  • pass sutures into the tunnels through the LCL
  • repeat with 2-3 sutures

5

Tie sutures

  • place the elbow in 90 degrees of flexion and pronation when tying sutures
N

Wound Closure

1

Irrigation and hemostasis

  • irrigate wounds thoroughly
  • deflate tourniquet (if elevated)
  • coagulate any bleeders carefully

2

Deep Closure

  • use 0-vicryl for deep closure

3

Superficial Closure

  • use 3-0 vicryl for subcutaneous closure
  • place subcutaneous drain
  • close skin with 3-0 nylon

4

Dressing and immediate immobilization

  • soft dressing (gauze, webril)
  • place in splint at 90 degrees of flexion and pronation
  • sling for comfort
Postoperative Patient Care
 

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