Aims: Exposure of the pediatric elbows for fixation of medial
condylar and epicondylar fractures with or without dislocation is
usually difficult through the direct medial approach due to the small
sized elbows, associated marked edema which makes exposure of the
ulnar nerve and direct visualization and reduction of the fracture
difficult tasks in some cases, disruption of the ulnar collateral
ligament and the flexor-pronator muscles during dissection,
discomfort for the surgeon, improper insertion of Kirschner wires
for definite fixation through the incision which makes the skin
closure difficult, lastly; some surgeons bend the K. wires in attempt to
protrude them through the skin away from the incision which may
sometimes affect the reduction.
Methods: In order to overcome these difficulties we describe the
posteromedial approach instead of direct medial approach for fractures
which are actually posteromedial, this approach allows access to the
fracture site by an incision directly over the ulnar nerve to avoid nerve
traction or injury, it provides direct clear vision of the fracture site
however the swelling is without disruption of ligaments, and allows
easier insertion of K. wires through the intact skin away from the
incision.
Conclusion:-
Posteromedial approach to medial condyle is a good surgical option
for open reduction and pinning or fixation of medial condylar
fractures in children. It is safe, easy, extensile with good exposure of
both the ulnar nerve and fracture site, and with less complications.