elbow frac ppt
TRANSCRIPT
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ELBOW FRACTURES
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Distal humerus1. supracondylar fractures, 2. transcondylar fractures, 3. intercondylar fractures, 4. fractures of the condyles 5. fractures of the articular surfaces (capitellum
and trochlea)6. fractures of the epicondyles.• Intra articular fractures• Muscle forces
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EXTRA - ARTICULAR
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PARTIAL - ARTICULAR
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COMPLETE - ARTICULAR
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JUPITER AND MEHNE
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NON SURGICAL MANAGEMENT
• Medically unfit
• Paralytic arm
• undisplaced
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SURGICAL MANAGEMENT
• PRINCIPLES-1.Open reduction – reconstruct the articular
surface
2.Rigid fixation
3.Early mobilization
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Reconstruction of articular surface
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Rigid fixation
1. AO 90*-90* configuration
2. Parallel plate configuration
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Total elbow arthroplasty
• Indications-1.Grossly communited # in a osteoporotic pt
2.Pre existing rheumatoid arthritis.
3.If reconstruction impossible.
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early rehab
• Splint 30-40 * of flexion and neutral location• Allow healing of skin sutures• Active assisted exercises• Immobilize max 2-3 weeks• Resistance exercises at radiographic union or
8-12 weeks• After total elbow- do not pick up wt > 5
pounds
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Elbow arthrodesis
• severe bone or soft tissue loss.• chronic persistent infection,• concominant neurologic injury,• failed TEA• Unstable elbow
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Capitellar fractures
• Intra articular #
• Coronal plane
• No muscle attachment
• Can become a mechanical block if displaces ant.
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CORONOID FRACTURES
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Radial head fractures
• Isolated or as a complex injury• Now we know that radial head is not
expendable• Cx of excision-1.pain, joint instability, cubitus valgus
2.proximal radial translation,
3.Dec strength, osteoarthrosis
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TYPE 1
• Undisplaced fractures
• < 2mm displacement
• No mechanical blockRx- 1.sling till pain relief2.24-48 hrs later start active ROM exercises
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TYPE 2
• Less than 3 fragements• 1/3rd of the radial head • Rx-• ORIF –1.Mini condylar plate 2.Mini fragment screw3.Herbert, accutrak4.Mayo radial head plate
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REDIAL HEAD EXCISION
• TYPE 3- which are not amenable to ORIF
will need excision
• Provided there are isolated
• Early excision versus delayed excision
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arthroplasty
• Type 3 or 4 with-1.ligament injury 2.distal radioulnar joint injury3.coronoid fracture4.olecranon fracture that is displaced or
comminuted and unstable
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