Surgical Discussion

Brachialis smoked, capsule smoked, MUCL not repairable. Basically the only soft tissue structure intact was triceps. I made a kocher approach and found (as is typical) the LUCL and common extensor origin off the lateral epicondyle and repairable. Given the global instability and inability to repair medial structures I elected for 1) reduction 2) LUCL and CEO repair 3) internal ex-fix. Historically we would do 1 and 2 and then a static or hinged ex-fix. Hinged ex fixes were basically a disaster. Static ex fixes suck because you are guaranteed a super stiff elbow. The benefit of the internal ex fix is augmented stability and motion(as the soft tissues allow). The soft tissue injury was treated with primary closure and STSG. The in fix comes out between 3 and 6 months. I’ve seen this thing used with increasing frequency over the last few years for injuries that are otherwise repairable with early motion allowed. It’s not an off the shelf device for terrible triads and other variations of simple ligamentous injuries. But when you need it, it’s a good tool.

Orthopaedic implants used:   Skeletal Dynamics - IJS