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Arthroscopic Reduction and Internal Fixation of Elbow Fractures
Endoscopic and arthroscopic techniques afford unparalleled exposure while minimizing surgical trauma and nociception. Although the evolution of elbow arthroscopy is in its early stages, several trauma-related applications are promising. The slow adoption of arthroscopically assisted fixation of elbow fractures may be the result of surgeons’ lack of familiarity with elbow arthroscopy and lack of experience with elbow trauma in general. Arthroscopic elbow procedures range in difficulty from simple to challenging. Diagnostic arthroscopy and simple loose body removal are relatively straightforward. Next in the hierarchy of difficulty and risk are débridement, such as for the management of lateral epicondylitis (tennis elbow); arthroscopic reduction and internal fixation of elbow fractures; and osteocapsular arthroplasty for the management of arthritis. Posttraumatic contracture release, rheumatoid synovectomy, and the management of severe contracture requiring an extra-articular approach are the most challenging and risky procedures. Although elbow arthroscopy for trauma might seem difficult and risky, more often it is an intermediate challenge and risk because, unlike a severe, posttraumatic contracture, the fractured elbow was normal prior to the trauma. Thus, the capsule is normal, thin, and pliant, and the joint is distended by hematoma. Therefore, entry into the elbow is relatively easy and safe, and all work on the fracture is done within the capsule, thereby maintaining a barrier between it and the neurovascular structures. This chapter discusses the indications for arthroscopy in the management of elbow trauma, and reviews the basic steps and principles of arthroscopically assisted treatment of elbow fractures.