Acute elbow injury

Sumroeng Neti, M.D.Orthopaedic center

Bumrungrad International Hospital

LCL complex

4 bundles1. LUCL2. RCL3. Annular ligament4. Accessory LCL

Medial collateral ligament

Medial collateral ligame nt

“Biomechanical study of elbow ligaments”

Regan WD et al. Clin Orthop 1991 ;271:170-9Regan WD et al. Clin Orthop 1991 ;271:170-9

Tensile strength (N)

MCL anterior band

261

MCL posterior band

159

LCL 233

Palmaris longus 358Anterior band of MCL is the strongest

Biomechanical of the elbow

Andrew A.Amis : Prof.of Orthopaedic Andrew A.Amis : Prof.of Orthopaedic BiomechanicsBiomechanics

MCL complex is more important than LCL complex for functional stability Because the carrying angle biases the

loading towards valgus Anterior band of MCL is the strongest

elbow ligament Anterior band of MCL is isometric It is an important elbow stabilizer at all

angles of elbow flexion

Synovial membrane –Ant.

Synovial membrane – Post.

04/12/23 menumenu

- Proximal R U j - Proximal R U jointoint

Radial not ch of ulna

Pattern of injuries

Valgus instability Varus instability Olecranon #-dislocation

Anterior #-dislocation Posterior Olecranon #-dislocation

(Monteggia lesion)

Valgus instability

Valgus instability Valgus + axial load #radial head Pure valgus MCL injury

(overhead throwing athletes)

Valgus + axial load + ext.rotation PLRI : elbow dislocation (Horii circle)

Valgus + axial load + ext.rotation PLRI : elbow # - dislocation +/- #radial head, +/- #coronoid

Valgus instability Valgus + axial load Compressive failure #radial head

Valgus instability Valgus + axial load Compressive failure #radial head

Valgus + axial load #radial head

Valgus + axial load #radial head

Valgus instability Pure valgus MCL injury

Distractive failure (overhead throwing athletes)

Valgus instability Pure valgus MCL injury

Distractive failure (overhead throwing athletes)

Valgus instability Pure valgus MCL injury Distractive failure

(overhead throwing athletes)

Surgical repair is performed by placing two limbs of a running, locked number-2 nonabsorbable suture through the substance of the medial collateral ligament. Drill-holes are prepared at the footprint of the medial collateral ligament on the medial epicondyle with an anterior and a posterior bone tunnel

Fig. 5-B The sutures are tied over the bone bridge with the elbow held in slight varus and

flexion.

Surgical Technique

The -avulsed flexor pronator tend on was repaired to the residual ten

don with use of - -interrupted figure of eight nona

bsorbable sutures. Finally, the ulnar nerve was transp

osed anteriorly with use of a fascia l sling.

Valgus instability Valgus + axial load #radial head Pure valgus MCL injury

(overhead throwing athletes)

Valgus + axial load + ext.rotation PLRI : elbow dislocation (Horii circle)

Valgus + axial load + ext.rotation PLRI : elbow # - dislocation +/- #radial head, +/- #coronoid

PLRI : PosteroLateral Rotational Instability

Valgus + axial load + ext.rotation PLRI : elbow dislocation

Horii circle Stage 1 : disrupted LUCL = PLRI Stage 2 : A-P capsule = Perched Stage 3 : disrupted MCL = Dislocation

PLRI : PosteroLateral Rotational Instability

Valgus + axial load + ext.rotation PLRI : elbow dislocation

PLRI : PosteroLateral Rotational Instability

Valgus + axial load + ext.rotation PLRI : elbow dislocation

Valgus instability - PLRI Valgus + axial load + ext.rotation

PLRI : elbow # - dislocation

+ #radial head

Valgus instability - PLRI Valgus + axial load + ext.rotation

PLRI : elbow # - dislocation

+ #radial head

Valgus instability - PLRI Valgus + axial load + ext.rotation

PLRI : elbow # - dislocation

+ #coronoid

ORIF # coronoid process

Valgus instability - PLRI Valgus + axial load + ext.rotation

PLRI : elbow # - dislocation

+ #radial head, #coronoid = Terrible triad

Terrible triad

Pattern of injuries

Valgus instability Varus instability Olecranon #-dislocation

Anterior #-dislocation Posterior Olecranon #-dislocation

(Monteggia lesion)

Varus instability

Varus instability : PMRI Varus + axial load (+/- int.rotation) elbow #-subluxationStage 1 #coronoid (anteromedial facet)Stage 2 LCL disruption

Varus instability : PMRIStage 1 :Coronoid # (anteromedial facet)

elbow subluxation

Minor coronoid # ?

Varus instability : PMRIStage 2 :Coronoid # + LCL disruption

elbow subluxation

Thank you