Surgical Discussion

The medial most aspect of the trochlea was fractured at the trochlea's attachment to the medial epicondyle. No total elbow system available. So, I placed a tension band, with the bent part of the distal wires IN the joint, no other place. I also placed a cerclage around the mid portion of the "spool" of the trochla - again, IN the joint. I figured I could come back later and do the TEA PRN, but the metal in the joint was smooth and might be accomidated. I

In the skinny wire technique the smooth wires are trapped under a plate. This prevents their migration, and allows use of smooth wires. I believe that linking them together also increases overall strength of the construct (like O'Driscoll's original description of using the keystone of an arch with non-locking screws). The capture of the smooth wire prevents migration, which mitigates the need for threaded wires, and there is some "give" of flexibility of the wire, such that if captured at the plate (typically laterally) and fixed in solid bone in the medial column, the midportion will give a dynamic push, but allow for some collapse with healing. IF there's some exposure of the wired down the road, at least it's smooth. The wires are easy to get out if needed, and lastly, i've found smooth wires are available in Ethiopia when I go there, and threaded are not. In any case, next time you are all using distal, subchondral wires, try locking them under a plate like Dyer showed us and see what you think. Attached is my favorite skinny wire cases - there is one headless screw, otherwise only a few dollars of hardware, even in the US. Case credit: Dr Rick Papandrea.