Pre-op Diagnosis: Closed fracture of distal left humerus
Post-op Diagnosis: Same as Pre-op
Procedure(s): Left – OPEN REDUCTION INTERNAL FIXATION DISTAL HUMERUS VIA OLECRANON OSTEOTOMY- Wound Class: Clean
Proc. Description(s) & CPT Code(s): OPEN REDUCTION INTERNAL FIXATION DISTAL HUMERUS:
Anesthesia: General
Complications: none
Findings: complex fx
Technique:
The patient was taken to the OR and given general anesthesia. A foley catheter was placed. A time out was done. Prophylactic IV antibiotics were given. He was placed in the lateral position on the beanbag with all bony prominences padded. The patient and site were identified. The left upper extremity was prepped and draped in the usual sterile fashion.
We did a standard posterior approach to the right humerus. We isolated and protected the ulnar nerve. We predrilled for the olecranon plate. We did an olecranon osteotomy with a saw and osteotome. We exposed the distal humerus fracture using the detached lateral epicondyle to sublux the elbow. We reduced the articular surface which was. There was comminution. We fixed the articular surface with k-wires and then headless compression screws. We then fixed the epicondyle and articular surface to the shaft using a skeletal dynamics lateral plate with capitellar extension. We fixed the plates to bone using locking and non-locking screws gain solid fixation. We confirmed reduction and hardware position with fluoroscopy. We ranged the elbow and were satisfied with the reduction and stability. The ulnar nerve appeared okay. We then reduced the olecranon and fixed it with a plate. We again confirmed reduction and hardware position with fluoroscopy, and ranged the elbow and were satisfied with the reduction and stability and checked the ulnar nerve. We reinforced the epicondylar repair with fiberwire around the plate and reinforced the olecranon repair with fiberwire through the triceps.
The wound was thoroughly irrigated out, hemostasis was obtained, and closure was accomplished with vicryl and nylon. Vancomycin and Tobramycin were placed in the wound. Dressing was placed.
The patient was then awoken and tolerated the procedure well and was taken to recovery in stable condition.
24575 OPEN TX HUMERAL EPICONDYLAR FRACTURE; (-LT Left side of body)
S42.452A – Displaced fracture of lateral condyle of left humerus, initial encounter for closed fracture
S42.462A – Displaced fracture of medial condyle of left humerus, initial encounter for closed fracture
