Displaced supracondylar fracture in adults often require internal fixation. Plate fixation, requires soft tissue stripping resulting in devitalisation of bony fragments and this predisposes to risk of non union, infection and nerve injuries. This is the first report of a new technique, locked intramedullary transolecranon fossa nailing.

In this technique the fracture is exposed through a limited posterior triceps splitting incision, keeping the soft tissue stripping to the minimum. The medullary canal is entered proximally through an anterior shoulder incision. A guide wire is inserted in an antegrade manner to enter the fracture site. The distal fragment is predrilled to create a tract with 3.2mm drill from proximal to distal, in such a way that the drill enters the olecranon fossa and then the proximal part of trochlea avoiding penetration of the elbow joint. The guide wire is then advanced into the tract in the distal segment. The medullary canal is reamed over the guide wire in anti-grade fashion with flexireamer. Utilising the standard antegrade technique, the nail is inserted and advanced under direct vision until tip of the nail is firmly seated in the trochlea. The proximal and distal locking are done in standard fashion. Postoperatively active mobilisation is encouraged. Four patients underwent this procedure. All the fractures healed in 3 months and at one year follow up the average arc of elbow motion is 120 degrees. There are no complications.

Transolecranon fossa locked nailing is an available option to treat the displaced supracondylar fracture of humerus in adults.

There are many difficulties associated with the localisation of the symptomatic segment in patients presenting with cervicobrachial pain with no evidence of impaired conduction in the nerve root. Ancillary radiological investigations such as myelography, epidural phlebography, and epidural myelograms are of unreliable diagnostic value. However, discography can be of value if the technique described here is used. Infiltration of the cervical nerve root with local anaesthetic has also proved useful in the localisation of the symptomatic segment. The techniques used in cervical discography and infiltration of the nerve root are described and their reliability is assessed.