| An example of a difficult management problem. This patient is a mid 60s year old woman who sustained multiple injuries in a motor vehicle accident, including bilateral calcaneal fractures and a closed distal humerus fracture. She was initially treated in another city. |
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| Initial injury: |
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| Initial fixation: |
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| Films on arrival, one week after surgery. Neurovascular exam is normal. Early loss of fixation. |
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| The fracture complex was assessed as the following, with central comminution - Posterior view: |
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| The lateral epicondyle was found to have additional coronal comminution - Lateral view: |
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| The medial column had a narrow proximal cortical strut remaining - medial view: |
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Taking all factors into account, including
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| A triangle of tension bands was constructed using 1.6 and 2.0 mm pins, with the most distal pin transfixing all four distal fracture fragments. It would have been possible to add a wire through the center of the cannulated screw for an additional cerclage proximally, but this was not done because of concerns regarding corrosion at the titanium/stainless contact point. Although one pin appears to be within the old cannulated screw, it is not. |
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| Finally, the titanium olecranon screw was replaced with a longer 6.5 mm stainless screw and tension band wire. Following this, the elbow was stabilized with an EBI hinged external fixator (not shown), planning to leave this on four weeks, anticipating inadvertent weight bearing due to the patient's bilateral calcaneal fractures. |
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