Elbow Fractures: Fixation With a Plate and Screws

Elbow Fractures: Fixation With a Plate and Screws

This surgical video demonstrates the repair of an elbow fracture using a plate and screws. The patient has a fracture at the coronoid process of the ulna, a forearm bone that forms part of the elbow joint. Here, we see a left arm. The patient is lying face up on the operating table. Their head is toward the right side of the screen, and their feet are toward the left side of the screen. The left arm is outstretched to see the inner side of the elbow.

The surgeon has already used a skin marker to mark out where the incision will be made. The surgeon begins by cutting through the skin and underlying soft tissue and muscle to identify and protect the median and ulnar nerves. Next, the surgeon drills 2 holes and uses a saw to cut through bone at the bottom of the inner side of the upper arm bone, called the medial epicondyle. This creates a flap that can be peeled back to reveal the coronoid process. The surgeon will move the flap back into its original position after repairing the elbow fracture.

Although it is not seen here in this cadaveric demonstration, the fracture segments would be put back together before the surgeon places the metal plate onto the coronoid process, and a ball-headed pin is inserted through the plate to secure its position. In the middle of the plate, the surgeon drills a hole and measures its length. An appropriately sized screw is screwed into the plate. This process is repeated for the other screws in the plate.

The surgeon will confirm the placement of the plate using x-ray. Using the drill holes that were made earlier, the surgeon passes a small metal pin through the underside of the upper arm bone that was cut and places the other end in the same hole on the base of the upper arm bone. This helps to bring the muscle and bone back to their original position. The surgeon places a screw into the bottom hole through both parts of the upper arm bone. Then, they remove the pin and place another screw into the top hole.

The surgeon checks the repair and will close the skin incision with sutures. The procedure is complete.