Name of the Procedure:

Percutaneous Skeletal Fixation of Humeral Condylar Fracture, Medial or Lateral, with Manipulation

Summary

This procedure involves the minimally invasive manipulation and securing of a fractured humeral condyle using pins or screws.

Purpose

The procedure aims to stabilize fractures of the humeral condyle, which is a key part of the elbow joint, to ensure proper healing and to restore the normal function and range of motion of the elbow.

Indications

• Acute humeral condylar fractures, either medial or lateral.
• Severe pain, swelling, and inability to move the arm due to the fracture.
• Patients in whom conservative treatment (like casting) is deemed insufficient for bone healing.

Preparation

• Fasting for at least 8 hours prior to the procedure.
• Evaluation including X-rays or CT scans to assess the fracture.
• Review of the patient's medical history and current medications; instructions may be given to stop certain medications like blood thinners.

Procedure Description

1. The patient is placed under general anesthesia or regional block anesthesia.
2. The surgeon makes a small incision near the elbow joint.
3. Using fluoroscopy (live X-ray), the surgeon manipulates the fractured bone segments into proper alignment.
4. Kirschner wires (K-wires) or screws are inserted percutaneously to stabilize and fix the bone fragments.
5. The incision is closed, and a sterile dressing is applied.

Duration

Typically, the procedure takes about 1 to 2 hours.

Setting

The procedure is usually performed in a hospital's operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Radiologic technologist for fluoroscopy

Risks and Complications

• Infection at the site of pin or screw insertion
• Nerve damage resulting in temporary or permanent loss of function
• Non-union or malunion of the fracture
• Equipment failure, such as pin migration
• Complications related to anesthesia

Benefits

• Stabilizes the fracture to facilitate proper healing.
• Restores the functionality of the elbow joint.
• Minimally invasive approach reduces recovery time and scarring.

Recovery

• Immobilization of the elbow with a splint or brace for several weeks.
• Pain management with medications prescribed by the doctor.
• Gradual physical therapy to restore range of motion and strength.
• Full recovery can take from 6 weeks to a few months, depending on the severity of the fracture and the patient's overall health.

Alternatives

• Closed reduction and casting: Non-surgical but may result in improper bone alignment.
• Open reduction and internal fixation (ORIF): More invasive but allows for direct visualization and correction of the fracture.
• Pros of percutaneous fixation include less invasive nature and quicker recovery; cons include potential for less stable fixation compared to ORIF.

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel pain. Post-procedure, there may be some pain and discomfort which is manageable with analgesics. Gradual improvement in elbow movement and reduced pain will be experienced over the following weeks with guided physical therapy.