Elbow Fractures - Horus University in Egypt PDF

 The Elbow Ahmed Salah El-Din Zaghloul Lecturer of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Mansoura University  Any Fracture Classificat Commonest Definitive Deformity ion Complicatio...

 The Elbow Ahmed Salah El-Din Zaghloul Lecturer of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Mansoura University  Any Fracture Classificat Commonest Definitive Deformity ion Complication TTT Relation of the General distal General EF Specific Fragmen Local CR & EF t to OR & IF Proximal Fragmen t  Supracondylar Fracture Humerus De Metaphyseal area of humerus just f above condyles. % Commonest elbow injury in children. A/ E  Direct: o Very rare.  Indirect: o Fall on outstretched hand (Ext. Type). o Fall on tip of flexed elbow (Flex. Type).  Supracondylar Fracture Classificat Humerus ion Type Extension Flexion Falling on Outstretched Hand Fall on tip of flexed elbow A/E Deformi Distal segment is displaced backward Distal segment is displaced forward ty & upward & upward  Supracondylar Fracture Classificat Humerus ion Gartland Classification  Supracondylar Fracture Complicati Humerus ons Skin  As B4. Muscles  Tear of Brachialis Ms ( Brachialis Sign). Myositis ossificans. Vascular  Brachial a. injury. Compartment Syndrome. Volkmann's ischemic contracture. Nerve  Median (Ant interosseus n), Ulnar, Radial. TT EF  AES for 4-6 w. Bone  Cubitus CR & EF varus: T AES 4-6 w. CR &loss of carrying Pinning  AES. angle & delayed ulnar neuritis. OR & Pinning  AES.  Elbow Dislocation % 3rd most common major joint dislocation (Shoulder, Hip). A/  Direct: E Sideswipe Injury: Baby car injury, Traffic elbow injury Fall on tip of flexed elbow.  Indirect: Fall on outstretched hand. Violent Ms Contraction: Weightlifting & CrossFit. Classifica Based on displacement of tion ulna relative to humerus: o Posterior. o Anterior. o Medial. o Lateral. o Divergent.  Elbow Dislocation Classificat ion  Posterior: o Posterior. o Posterolateral: Most Common. o Posteromedial.  Divergent: o Sagittal Plane. o Coronal Plane.  Elbow Dislocation C/P Loss of normal Equilateral Triangle ( ):  Medial Epicondyle.  Lateral Epicondyle.  Olecranon. Complicati ons Skin  As B4. Muscles  Myositis ossificans. Vascular  Compartment Syndrome. Volkmann's ischemic contracture. Brachial a. injury. Nerve  Median , Ulnar. Bone  Associated Fractures: Head Radius, Coronoid fractures. Joint  Recurrence & Persistent  Elbow Dislocation TT T CR  N-V Assessment before & after Reduction.  Under General Anesthesia or Sedation. EF (Immobilization)  AES 2-3 w. Gradual Mobilization  Early Active ROM. Myen & Guigley Traction & Counter  Olecranon Fracture A/  Direct: E Subcutaneous Position. Fall on tip of flexed elbow.  Indirect: Fall on outstretched hand. Violent Ms Contraction: Throwing Athletes.  Stress Fracture. Classifica Mayo tion Classification Based on Elbow Stability & Comminution. C/ P  Palpable defect.  Loss of active Elbow Extension.  Ulnar nerve injury.  Olecranon Fracture Complicati Local  Symptomatic Hardware. ons  Myositis Ossificans. TT  Ulnar Neuritis. T EF  AES for 3 weeks. OR & IF  Tension Band Wiring.  Screw.  Plate & Screws.  Radial Head & Neck Fractures % Neck Fractures common in Children (9-10y). Head Fractures common in Adults. A/  Direct: Rare. E  Indirect: Fall on outstretched hand. Classifica Neck Fractures: O'Brien Classification. tion Head Fractures: Mason Classification. O'Brien Mason  Radial Head & Neck Fractures C/P Localized tenderness over radial head & neck. Painful pronation & supination. TT T EF  AES for 1-2 weeks & Early Mobilization. CR & Pinning  Percutaneous or IM. OR & IF  Screws Or P&S. Radial Head Arthroplasty. Radial Head Excision.  Lateral Epicondylitis De Overuse injury at Common Extensor f Origin: Muscles (ECRL, ECRB, ED, EDM, ECU, Anconeus). % Commonest causeLRCL). Ligaments ( LUCL, elbow pain. Patholo gy  Activities: Repetitive Supination & Pronation of Extended Elbow (Tennis Players).  Microtear: Microtears at origin of ECRB +/- ECRL & ECU.  Angio fibroblastic Hyperplasia: o Fibroblast Hypertrophy. o Disorganized Collagen. o Vascular Hyperplasia.  Lateral Epicondylitis C/  Pain. P   Grip Strength.  Provocative Tests: Resisted Finger & Wrist Extension. DD  Radial Tunnel Syndrome: Compressive neuropathy of the posterior interosseous nerve (PIN) at the level of proximal forearm TT (Radial Tunnel). T Conservativ Rest. e TTT Splint: Counter – force Brace (Strap). Medication: NSAIDs. Activity Modification: Physiotherapy. Operative TTT Indications: Failed conservative for 4 - 6 m. Methods: Release & Debridement.