©ken l schreibman, phd/md 2010 schreibman.info elbow trauma anatomy 3d dislocations radial...
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©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Trauma Anatomy
3D Dislocations
Radial Head Fractures
Radial HeadForearm
PatternsChildren
Examining Elbow Radiographsschreibman.info
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow AnatomyCapitellum[L. small head] ball-shaped
Trochlea[Gr. pulley] spool-shaped
Radial Head disc-shaped
Olecranon[Gr. elbow]
ULNA
RADIUS
TROC CAP
HUMERUS
HEADOLEC
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy HUMERUS
RADIUS
CAP
ULNA
TROC
OLECRANON
CORONOIDON
CORACOID
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy HUMERUS
RADIUS
CAP
ULNA
TROC
OLECRANON
CORONOIDON
CORONOID
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Dislocations
LateralView
Olecranon & Radial HeadEasy!
APView
APView
Relocated
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Dislocations: Parallelism
APView
Relocated
APView
Dislocated
ParallelArticularSurfaces
ParallelArticularSurfaces
Lack ofParallelism
Lack ofParallelism
LateralView
Relocated ParallelArticularSurfaces
ParallelArticularSurfaces
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow DislocationsOlecranon & Radial HeadEasy!
Radial Head OnlyCan be very subtle
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Keys to Examining ElbowsRadial Head points to Capitellumon all views
1)
2)
3)
4)
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy HUMERUS
RADIUS
CAP
ULNA
TROC
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy HUMERUS
RADIUS
CAPTROCRadial Headpoints to
Capitellum
Radial Headpoints to
Capitellum
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
Radial Headpoints to
Capitellum
Radial Headpoints to
Capitellum
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
Radial Headpoints to
Capitellum
Radial Headpoints to
Capitellum
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
Radial Headpoints to
Capitellum
Radial Headpoints to
Capitellum
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
Radial Headpoints to
Capitellum
Radial Headpoints to
Capitellum
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
Radial Headpoints to
Capitellum
Radial Headpoints to
Capitellum
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
Radial Headpoints to
Capitellum
Radial Headpoints to
Capitellum
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
Radial Headpoints to
Capitellum
Radial Headpoints to
Capitellum
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
Radial Headpoints to
Capitellum
Radial Headpoints to
Capitellum
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
Radial Headpoints to
Capitellum
Radial Headpoints to
Capitellum
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
Radial Headpoints to
Capitellum
Radial Headpoints to
Capitellum
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
Radial Headpoints to
Capitellum
Radial Headpoints to
Capitellum
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
Radial Headpoints to
Capitellum
Radial Headpoints to
Capitellum
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
Radial Headpoints to
Capitellum
Radial Headpoints to
Capitellum
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
Radial Headpoints to
Capitellum
Radial Headpoints to
Capitellum
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
Radial Headpoints to
Capitellum
Radial Headpoints to
Capitellum
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
Radial Headpoints to
Capitellum
Radial Headpoints to
Capitellum
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
Radial Headpoints to
Capitellum
Radial Headpoints to
Capitellum
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Anatomy
Radial Headpoints to
Capitellum
Radial Headpoints to
Capitellum
©Ken L Schreibman, PhD/MD 2010 schreibman.info
AP LateralCongenital Radial Head Dislocation4 year-old maleNo traumaCould not
supinate arm
Lateral
RightLeft
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow DislocationsOlecranon & Radial HeadEasy!
Radial Head OnlyCan be very subtle
©Ken L Schreibman, PhD/MD 2010 schreibman.info
10 year-old femaleAP Lateral--------- Not a True Lateral
True Lateral
Monteggia Fracture
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Monteggia Fracture
ULNA
HUMERUSCAP
TROC
CARPUS
FALL
RADIUS
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Monteggia Fracture
HUMERUS
ULNA
CAP
TROC
CARPUS
FALL
RADIUS
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Monteggia FracturePost Reduction
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Monteggia FractureGiovanni Battista Monteggia (1762-1815)Greatest Italian Surgeon
beginning 19th century
Hunter, Peltier, LundRadioGraphics2000:20;819-836
Fx Prox 1/3 UlnaAnt Disloc Rad Head
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Monteggia Fracture
Bado’s classification of Monteggia fractures
Hunter, Peltier, LundRadioGraphics2000:20;819-836
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Monteggia Fracture
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Monteggia Fracture
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Forearm Fractures
ULNA
HUMERUSCAP
TROC
CARPUS
FALL
RADIUS
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Forearm Fractures
ULNA
HUMERUSCAP
TROC
CARPUS
FALL
RADIUS
: Galeazzi: Galeazzi
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Riccardo Galeazzi (1866-1952) Developed Orthopedic Rehab in ItalyCrippled soldiers/children wounded WWI
Galeazzi Fracture
Hunter, Peltier, LundRadioGraphics2000:20;819-836
Fracture Middle-Distal ⅓ RadiusDislocation of the Distal Radio-Ulnar Joint (DRUJ)
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Galeazzi Fracture << Monteggia
Fracture Middle-Distal ⅓ RadiusDislocation of the Distal Radio-Ulnar Joint (DRUJ)
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Monteggia vs Galeazzi: mnemonic
HUMERUS
ULNA
CAP
TROC
CARPUS
FALL
RADIUS
ULNA
HUMERUSCAP
TROC
CARPUS
FALL
RADIUS
MU/GRM GU R
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Forearm Fractures
ULNA
HUMERUSCAP
TROC
CARPUS
RADIUS
: Nightstick Fx: Nightstick Fx
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Forearm Fractures: Nightstick Fx: Nightstick FxChicago, 1968
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Forearm Fractures
2 months later
: Nightstick Fx: Nightstick Fx
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Both Bone Forearm Fracture
ULNA
HUMERUSCAP
TROC
CARPUS
FALL
RADIUS
Common in childrenCan look scary…
…but should heal well “if both ends of the bone are in the same room”
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Both Bone Forearm FractureAP View7 Months Later
Lateral View
12 year-old Male
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Essex-Lopresti Fracture
IOMULNA
HUMERUSCAP
TROC
CARPUS
FALL
RADIUS
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Essex-Lopresti FracturePeter Gordon Essex-Lopresti (1918-1951)British Surgeon, Air Borne Div, WWIIExpert on Parachuting InjuriesClassification scheme for Calcaneal Fxs
Radial Head Fx w/ Disruption DRUJ Displaced Rad Head Fx Examine Wrist Closely
Hunter, Peltier, LundRadioGraphics2000:20;819-836
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Essex-Lopresti Fracture
Impacted, ComminutedRadial Head Fracture
Impacted, ComminutedRadial Head Fracture
Lack ofParallelism
Lack ofParallelism
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Essex-Lopresti Fracture
Impacted, ComminutedRadial Head Fracture
Impacted, ComminutedRadial Head Fracture
Radial HeadProsthesis
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Essex-Lopresti Fracture
Lack ofParallelism
Lack ofParallelism
Parallel articular surfaces
Parallel articular surfaces
PostRadial HeadProsthesis
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Keys to Examining ElbowsRadial Head points to Capitellumon all viewsFat Pads are your Friend
1)
2)
3)
4)
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Fat PadsHUMERUS
ULNA
CAP
RADIUS
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Fat Pads
U L N AR A D I U S
HUMERUS
Anterior Fad Pad(Coronoid Fossa)Posterior Fad Pad
(Olecranon Fossa)
Resnickfig22-15
With a radial head fracture:Bleeding into joint
(hemarthrosis)Elevates the Fat Pads
CAP
Resnick fig22-16
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Fat Pads
U L N AR A D I U S
HUMERUS
CAP
Normally, can’t see Posterior Fat Pad(tucked in olecranon fossa)
Anytime youcan see it,indicates it is displaced…probably by hemarthrosis
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Keys to Examining ElbowsRadial Head points to Capitellumon all viewsFat Pads are your FriendMost Radial Head Fractures are non-displaced and hard to seeAdults = Radial Head Fracture
1)
2)
3)
4)
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elevated Fat Pad = Radial Head Fx
U L N AR A D I U S
HUMERUS
CAP
Lateral
APOblique
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elevated Fat Pad = Radial Head Fx
EXTROT
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Radial Neck is Outside Joint Capsule
Resnickfig22-15
Radial Neck fracturedoes not cause a hemarthrosis, anddoes not elevate the fat pads.
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Radial Neck is Outside Joint Capsule
Resnickfig22-15
No Fat PadElevation
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Keys to Examining ElbowsRadial Head points to Capitellumon all viewsFat Pads are your FriendAdults = Radial Head FractureChildren = Supracondylar Fx
1)
2)
3)
4)
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Anatomy
ULNA
RADIUS
HUMERUS
TROC CAP
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Anatomy
ULNA
RADIUS
HUMERUS
Articular surfaces unossified at birthOssify in orderC R I T O ECapitellumRad HeadInt (med) EpiTrochleaOlecranonExt (lat) Epi
: Ossification Centers: Ossification Centers
CAP
2 year-old female
…..2
…..4..6
…….8…
10
..12
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Fractures: Children
ULNA
RADIUS
HUMERUS
CAP
Supracondylar Fracture 60% Elbow Fxs in
Children SubtleGrossly
Displaced
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Fractures: Children
ULNA
RADIUS
HUMERUS
CAP
2 year-old female
Supracondylar Fracture 60% Elbow Fxs in
Children SubtleGrossly
Displaced
Right (painful side) Left (normal side)
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Fractures: ChildrenSupracondylar Fracture 60% Elbow Fxs in
Children SubtleGrossly
Displaced
Supracondylar Fracture 60% Elbow Fxs in
Children SubtleGrossly
Displaced
Right (painful side) Left (normal side)
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Supracondylar Fracture
Right (painful side) Left (normal side)
AnteriorHumeral
LineShould passthru middleCapitellum
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Keys to Examining ElbowsRadial Head points to Capitellumon all viewsFat Pads are your FriendAdults = Radial Head FractureChildren = Supracondylar Fx
Anterior Humeral LineShould pass thru middle ⅓
Capitellum
1)
2)
3)
4)
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Supracondylar Fracture
5 year-old female
Day of injury After 2 weeks After 5 weeks
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Keys to Examining ElbowsRadial Head points to Capitellumon all viewsFat Pads are your FriendAdults = Radial Head FractureChildren = Supracondylar Fx
(Lateral Condyle Fx)Anterior Humeral LineShould pass thru middle ⅓
Capitellum
1)
2)
3)
4)
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Fractures: ChildrenLateral Condyle Fracture2nd most common pediatric elbow Fx20% of elbow injuries in children
©Ken L Schreibman, PhD/MD 2010 schreibman.info
6 year-old female
Elbow Fractures: ChildrenLateral Condyle Fracture2nd most common pediatric elbow Fx20% of elbow injuries in children
Left (painful side)Right (normal side)
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Keys to Examining ElbowsRadial Head points to Capitellumon all viewsFat Pads are your FriendAdults = Radial Head FractureChildren = Supracondylar Fx
(Lateral Condyle Fx)Anterior Humeral LineShould pass thru middle ⅓
CapitellumWhen in doubt, get the other side
1)
2)
3)
4)
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Fractures: Children
C R I T O ECapitellumRad HeadInt (med) EpiTrochleaOlecranonExt (lat) Epi
…..2
…..4..6
…….8…
10
..12
CI
RT
O
E
14 year-old male
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Elbow Fractures: Children
14 year-old male
Left (painful side)Right (normal side)
Width of normalgrowth plate
Abnormallywidenedgrowthplate
Abnormallywidenedgrowthplate
Avulsion Medial Epicondyle“Little Leaguer’s Elbow”Traction common
tendon flexor-pronator group
Traction UCLResult of
valgus stressFall on out-
stretched handViolent
throwingcontractions
©Ken L Schreibman, PhD/MD 2010 schreibman.info
Keys to Examining ElbowsRadial Head points to Capitellumon all viewsFat Pads are your FriendAdults = Radial Head FractureChildren = Supracondylar Fx
(Lateral Condyle Fx)Anterior Humeral LineShould pass thru middle ⅓
CapitellumWhen in doubt, get the other side
1)
2)
3)
4)