Treatment of a coronal shear injury of the trochlea using a modified hedgehog-based technique through an anterior neurovascular interval approach: A case report

• Published in: International journal of surgery case reports Vol. 85; p. 106211
• Main Authors: Koëter, M., van Hugten, P.P.W., Emans, P.J., Ten Bosch, J.A.
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.08.2021; Elsevier
• Subjects: Anterior neurovascular approach; Case Report; Humeral trochlear fracture; Modified hedgehog-based technique; Humeral trochlear fracture; Anterior neurovascular approach; Case report; Modified hedgehog-based technique
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2021.106211

Surgical treatment for dislocated trochlear shear injuries is recommended due to its articular nature. However, the surgical exposure is often limited and large cartilaginous fragments with lack of subchondral bone stock makes a stable fixation technically challenging. Rapid swelling of the traumatized cartilage induces a size misfit between the cartilage of the fragment and the defect site. The use of a “modified hedgehog”-based technique might be a solution in these cases. However, this technique has only been described in chondral shear lesions of the knee. A fifteen-year-old boy fell out of the still rings during gymnastics at school and suffered trauma to his elbow. A CT-scan of the right elbow showed a coronal shear injury of the trochlea with accompanied lateral condyle fracture of the humerus. The patient was treated throughout an anterior neurovascular approach with a modified hedgehog-based technique with triple fixation by creating an interlocking match of the cartilage, application of fibrin glue and additional screw fixation. The anterior neurovascular interval approach provides a clear exposure of the fracture site which is useful for anatomic reduction and triple fixation. The subsequent modified hedgehog-based technique has only been described once in children with shear-off chondral fragments of the knee, without additional screw fixation. Adding a screw fixation of the fragment creates some collateral damage to the cartilage and might not be necessary in future cases. The anterior neurovascular approach seems elegant and provides adequate exposure. Furthermore, a modified hedgehog-based technique delivers a stable triple fixation of the osteochondral fragment. •Surgical treatment of coronal shear injury of the trochlea is challenging.•Anatomic reduction and stable fixation of a coronal shear injury is essential.•The anterior neurovascular approach provides extensive exposure of the fracture site.•A modified hedgehog-based technique delivers stable triple fixation.