JBJS essential surgical techniques · 2012
Distal Humeral Fracture Fixation with an Extensor Mechanism-on Approach.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Erpelding Jason M, Mormino Matthew A, Fehringer Edward V
Аннотация
INTRODUCTION: Open treatment of extra-articular and intra-articular distal humeral fractures can be effectively accomplished through an extensor mechanism-on approach.
STEP 1 PREOPERATIVE PLANNING: Assess all images for multiplane fracture lines involving the capitellum or trochlea.
STEP 2 OPERATIVE SETUP: Verify with fluoroscopy that the patient and arm positions allow for adequate imaging of the distal part of the humerus.
STEP 3 SURGICAL APPROACH: Perform medial and lateral arthrotomies posterior to the collateral ligament complexes and excise the intra-articular fat pad and posterior aspect of the capsule.
STEP 4 FRACTURE REDUCTION AND PROVISIONAL FIXATION: Reduce the distal humeral fragments anatomically under direct visualization posteriorly and indirectly with fluoroscopy using the intact sigmoid notch as a template for reduction.
STEP 5 DEFINITIVE FIXATION: Place multiple screws distally through the plates medially and laterally; each screw should be of maximal length and engage the opposite column.
STEP 6 WOUND CLOSURE AND POSTOPERATIVE MANAGEMENT: Remove the dressing on postoperative day two and begin full active-assisted elbow range of motion and grip-strengthening therapy program.
RESULTS: In our series of thirty-seven patients12, all fractures healed primarily with a median motion arc of 126° (range, 60° to 141°). The median triceps strength loss was 10% (range, 0% to 49%).
WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
STEP 1 PREOPERATIVE PLANNING: Assess all images for multiplane fracture lines involving the capitellum or trochlea.
STEP 2 OPERATIVE SETUP: Verify with fluoroscopy that the patient and arm positions allow for adequate imaging of the distal part of the humerus.
STEP 3 SURGICAL APPROACH: Perform medial and lateral arthrotomies posterior to the collateral ligament complexes and excise the intra-articular fat pad and posterior aspect of the capsule.
STEP 4 FRACTURE REDUCTION AND PROVISIONAL FIXATION: Reduce the distal humeral fragments anatomically under direct visualization posteriorly and indirectly with fluoroscopy using the intact sigmoid notch as a template for reduction.
STEP 5 DEFINITIVE FIXATION: Place multiple screws distally through the plates medially and laterally; each screw should be of maximal length and engage the opposite column.
STEP 6 WOUND CLOSURE AND POSTOPERATIVE MANAGEMENT: Remove the dressing on postoperative day two and begin full active-assisted elbow range of motion and grip-strengthening therapy program.
RESULTS: In our series of thirty-seven patients12, all fractures healed primarily with a median motion arc of 126° (range, 60° to 141°). The median triceps strength loss was 10% (range, 0% to 49%).
WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.