| 1 |
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| Make
a small stab incision on the posterior aspect of
elbow above the tip of olecranon. Open the incision
with an artery forceps. Insert AM pin just proximal
to olecranon fossa. Take care not to go too much
beyond anterior cortex using a drill guard |
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| 2 |
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Attach
drill guide and osteotomy guide to the AM pin. |
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| 3 |
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Select
a hole on the drill guide which will match the pre-op
planning. The dome cut by the guide should go thro both
the cortices and should not be too much away from the
CORA. Usually 2nd or 3rd hole from the hole occupying
AM pin is selected. |
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| 4 |
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Make
a stab incision in midline posteriorly at the level of
selected hole. Pass an artery forceps thro the stab and
split triceps till you reach the bone. Pass a small periosteum
elevator to develop sub-periosteal plane. |
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| 5 |
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Pass
a drill sleeve thro the drill guide. Mount a 2.5 mm drll
bit over electrical drill. Keep the length of drill bit
outside the drill sleeve to be around 20 mm (around equal
to the AP dia of humerus) |
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| 6 |
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| Make
multiple drill holes in the posterior anterior direction
perpendicular to the posterior surface of the humerus.
Take care to avoid injury to the ulnar nerve and
avoid going too much beyond anterior cortex. The
drill holes are generally 2-3 mm apart. |
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| 7 |
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Confirm the position of the drill holes
on the image intensifier. |
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| 8 |
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Use
the osteotome guide. Insert a 5 mm osteotome and connect
the drill holes to complete the osteotomy. |
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| 9 |
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With
a gentle valgus force complete the osteotomy. Using the
osteotome in the osteotomy site as a rachet translate
the distal fragment medially as you correct the angulation. |
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| 10 |
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Fix the osteotomy with cross k wires. |
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| 11 |
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Pass
2 kwires in latero-medial direction proximal to the osteotomy
and one transverse wire distal to the osteotomy. The position
of these wires can correct extension and rotational deformity
when present. |
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| 12 |
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Attach
miniexternal fixator clamps and rods in compression mode
as shown in the diagram. |
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| 13 |
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Extend the elbow to check the alignment. Also check for
extension and rotations. Changes if any can be made by
readjusting the fixator. |
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