Open Reduction Internal Fixation of a Medial Epicondyle Avulsion Fracture With Incarcerated Fragment.

PURPOSE: The purpose of this video is to present a technique for open reduction and internal fixation of a displaced unstable medial epicondyle avulsion fracture. METHOD: A 13-year-old boy presented 2 days after injury at our institution after sustaining a medial epicondyle avulsion fracture with incarcerated fragment and posterolateral dislocation of the elbow after a fall off a fence. He described paresthesia in the ulnar nerve distribution and demonstrated slight weakness to intrinsic hand strength on examination. He was urgently reduced under sedation in the emergency department using the Roberts maneuver, a technique consisting of a valgus stress with forearm supination with finger and wrist extension that uses muscle forces to extract the fragment. Successful reduction of the ulna-humeral joint and extraction of the incarcerated medial epicondyle was demonstrated on CT. The patient was then taken in a nonurgent fashion to the operating room for open reduction and internal fixation of the displaced medial epicondyle fracture. Intraoperative examination after fixation demonstrated a congruent and stable elbow. A long-arm cast was then applied. RESULTS: The video is 7-minute, 38-second duration in time and 461 MB in size. CONCLUSIONS: Although fixation of medial epicondyle avulsion fractures may be controversial, there are some indications for ORIF including incarcerated epicondylar fragment, suspected entrapment and dysfunction of the ulnar nerve, marked instability of the elbow, and open fracture. Presented in this video is a safe technique for ORIF of the displaced and unstable medial epicondyle avulsion fracture.

Shoulder Arthrodesis.

PURPOSE: The purpose of this video is to demonstrate the surgical technique of a shoulder arthrodesis for a patient with multidirectional instability and multiple failed previous surgeries. METHODS: A 25-year-old woman with a long history of left shoulder multidirectional instability in the setting of Ehlers-Danlos syndrome is shown undergoing a shoulder arthrodesis. The video demonstrates intraoperative patient positioning, approach, shoulder osseous and articular preparation, implant placement (narrow 4.5 dynamic compression plate), and wound closure. The video includes a brief case history with preoperative radiographic imaging, indications, and patient outcome with postoperative radiographic imaging. RESULTS: The video is 11 minutes, 34 seconds in time. CONCLUSION: This video demonstrates a left shoulder arthrodesis with successful glenohumeral positioning of 30 degrees/30 degrees/30 degrees flexion, abduction, and internal rotation, respectively, and functional ability to reach the mouth and top of the head.