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Traumatic Elbow Instability PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Traumatic Elbow Instability" by David Ring MD PhD.

This medical PowerPoint presentation is about traumatic elbow instability, a condition in which there is excessive movement of the elbow joint, leading to pain, instability, and a decreased range of motion. It usually results from an injury to the ligaments that stabilize the elbow joint.

There are different types of elbow instability based on the direction of the instability, including anterior (forward), posterior (backward), and lateral (sideways). Anterior instability is the most common type and is often caused by a fall on an outstretched hand or a direct blow to the elbow.

Symptoms of traumatic elbow instability include pain, swelling, tenderness, and a feeling of instability or looseness in the elbow joint. Treatment typically involves rest, physical therapy, and sometimes surgery to repair or reconstruct the damaged ligaments.

If left untreated, traumatic elbow instability can lead to chronic pain, reduced function, and the development of arthritis in the elbow joint. Therefore, it is important to seek medical attention promptly if you suspect you have this condition.

Tags : Traumatic Elbow Instability, elbow joint, Anterior instability, Orthopaedic Surgery, Orthopaedic Surgery PowerPoint presentation

Published on : Jun 23, 2023 | Views : 974 | Downloads : 2

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Traumatic Elbow Instability David Ring MD PhD Updated April 2016
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Simple Elbow Dislocation No associated fractures Complete or near complete capuloligamentous injury Extensive muscle injury Nearly always stable after reduction No advantage to surgery if stable No more than 2 weeks immobilization
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Elbow Dislocation Usually posterolateral Can dislocate with anterior band of MCL intact Posteromedial pattern Less common Possibly more unstable
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Slight Subluxation “Drop Sign” This is like pseudo-subluxation in the shoulder. The combination of extensive muscle and ligament injury and guarding due to pain create a slight sag. IMPORTANT: distinguish from subluxation that will cause articular damage Drop sign After active flexion exercises
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Slight Subluxation “Drop Sign” Management: Avoid varus stress (shoulder abduction) Active flexion Overhead exercises Drop sign After active flexion exercises
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Unstable Simple Elbow Dislocation Uncommon Older women (simple fall) Young men (high-energy)
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Unstable Simple Elbow Dislocation Ligament / muscle reattachment to epicondyles External fixation Cross pinning
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Cross Pinning Useful bail out Stiff and located is preferred to subluxation Stiffness usually worked out easily 2.0mm pins exit proximally for retrieval in case of breakage Can be placed with local Only needed for 3 weeks. Bury if needed longer
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Chronic Simple Elbow Dislocation Jupiter and Ring JBJS 2002 Treatment: Open reduction and hinged external fixation No ligament reconstruction 5 patients: dislocated for 2 to 9 months Stable elbow, > 100 degrees motion in all patients
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Medial Collateral Ligament Insufficiency Throwing athletes Chronic attenuation Inability to throw 95 mph fastballs
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LCL Insufficiency Recurrent Simple Elbow Dislocation Insufficiency of the lateral collateral ligament Adolescent elbow dislocation Iatrogenic
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Traumatic Elbow Instability Associated with Fractures
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Definition Fracture-dislocation of the elbow Dislocation of the elbow Intra-articular fracture
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Definition Traumatic Elbow Instability Injury that destabilizes the elbow With or without dislocation
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Patterns of Traumatic Elbow Instability With Fracture Dislocation with Articular Fracture Olecranon Fracture-Dislocations Posterior Anterior Dislocation + radial head fracture Terrible Triad Varus posteromedial rotational instability
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Dislocation vs. Disruption Dislocation Disruption
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Dislocation vs. Disruption Dislocation Disruption
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Dislocation vs. Disruption Dislocation Disruption Ligaments Partially Spared
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Disruption Ligaments Partially Spared
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Patterns of Traumatic Elbow Instability With Fracture Dislocation with Articular Fracture Olecranon Fracture-Dislocations Posterior Anterior Dislocation + radial head fracture Terrible Triad Varus posteromedial rotational instability Dislocation Injuries Disruption Injuries
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Posterior Dislocation + Radial Head Fracture
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Posterior Dislocation + Radial Head Fracture 24 patients Ulnohumeral dislocation with radial head fracture Cast 1 month +/- radial head resection “Results better than generally thought” Secondary procedures for radial head No problems with instability
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Posterior Dislocation + Radial Head Fracture 23 patients Excision of radial head and cast INSTABILITY in patients with CORONOID fractures (4 patients)
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Terrible Triad Posterior dislocation Radial head fracture Coronoid fracture
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Terrible Triad Only patients with INSTABILITY had CORONOID fractures (4 patients)
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Terrible Triad Ring, Jupiter, Zilberfarb JBJS 2002 11 patients Regan and Morrey Type 2 coronoid fractures 7 redislocated in splint or cast 5 redislocated after operation Only 4 patients with satisfactory results
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Terrible Triad Pugh DM, Wild LM, Schemitsch EH, King GJ, McKee MD Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. J Bone Joint Surg Am. 2004 Jun;86-A(6):1122-30.
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Regan and Morrey Based on single lateral radiograph Type 1: Tip avulsion Type 2: < 50% coronoid height Type 3: > 50% coronoid height
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O’Driscoll Classification 1 3 2
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Varus Posteromedial Rotational Injuries Inadequate Treatment
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Olecranon Fracture-Dislocations Anterior (trans-olecranon) fracture-dislocations Posterior (posterior Monteggia) fracture-dislocations
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Anterior (Trans-Olecranon Fracture-Dislocation of the Olecranon
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Anterior (Trans-Olecranon) Fracture-Dislocation of the Olecranon
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POSTERIOR MONTEGGIA TYPE FRACTURE-DISLOCATION Posterior Fracture-Dislocation of the Olecranon
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POSTERIOR MONTEGGIA TYPE FRACTURE-DISLOCATION Posterior Fracture-Dislocation of the Olecranon
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Principles of Treatment Restore contour and dimensions of trochlear notch Contoured dorsal plate Fixation of coronoid Bridge fragmentation
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Treatment Tips Pin the olecranon to the trochlea Consider a temporary external fixator for a complex fracture
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Coronoid Exposure Through an olecranon fracture Lateral Kaplan interval with elevation of ECRL origin Removal of radial head fragments Medial Over the top (tip) Split in FCU by ulnar nerve (medial facet) Elevate entire flexor-pronator mass from dorsal (base fracture)
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Coronoid Provisional Fixation Coronoid fixation with plate then reduce and fix olecranon Pin fragments to trochlea Need to immobilize the elbow
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Exercises During Recovery If the LCL is injured, avoid varus stress (shoulder abduction) for 3-4 weeks. Overhead exercises can be helpful. If fixation is tenuous a 3-4 week period of immobilization is acceptable Active, self-assisted elbow flexion and extension and forearm rotation are the key Encourage patients to get into a “healthy stretch” mindset. It hurts, but it helps.
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Summary The LCL is more important than the MCL The ligaments will heal if you keep the elbow concentric, even when treated late Active motion adds to stability (avoid varus stress) Even small coronoid fractures can be a problem
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Patterns of Traumatic Elbow Instability With Fracture Dislocation with Articular Fracture Olecranon Fracture-Dislocations Posterior Anterior Dislocation + radial head fracture Terrible Triad Varus posteromedial rotational instability Dislocation Injuries Disruption Injuries
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Review Articles for Reference 1: Rodriguez-Martin J, Pretell-Mazzini J, Andres-Esteban EM, Larrainzar-Garijo R. Outcomes after terrible triads of the elbow treated with the current surgical protocols. A review. Int Orthop. 2011 Jun;35(6):851-60. Epub 2010 May 8. Review. PubMed PMID: 20449590; PubMed Central PMCID: PMC3103950. 2: Mathew PK, Athwal GS, King GJ. Terrible triad injury of the elbow: current concepts. J Am Acad Orthop Surg. 2009 Mar;17(3):137-51. Review. PubMed PMID: 19264707. 3: Ring D. Displaced, unstable fractures of the radial head: fixation vs. replacement--what is the evidence? Injury. 2008 Dec;39(12):1329-37. Epub 2008 Aug 13. Review. PubMed PMID: 18703190. 4: Cheung EV. Chronic lateral elbow instability. Orthop Clin North Am. 2008 Apr;39(2):221-8, vi-vii. Review. PubMed PMID: 18374812. 5: Grace SP, Field LD. Chronic medial elbow instability. Orthop Clin North Am. 2008 Apr;39(2):213-9, vi. Review. PubMed PMID: 18374811. 6: Ring D. Instability after total elbow arthroplasty. Hand Clin. 2008 Feb;24(1):105-12. Review. PubMed PMID: 18299024. 7: Dipaola M, Geissler WB, Osterman AL. Complex elbow instability. Hand Clin. 2008 Feb;24(1):39-52. Review. PubMed PMID: 18299019. 8: Martin BD, Johansen JA, Edwards SG. Complications related to simple dislocations of the elbow. Hand Clin. 2008 Feb;24(1):9-25. Review. PubMed PMID: 18299017.
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Review Articles for Reference 9: Tejwani NC, Mehta H. Fractures of the radial head and neck: current concepts in management. J Am Acad Orthop Surg. 2007 Jul;15(7):380-7. Review. PubMed PMID: 17602027. 10: Sotereanos DG, Darlis NA, Wright TW, Goitz RJ, King GJ. Unstable fracture-dislocations of the elbow. Instr Course Lect. 2007;56:369-76. Review. PubMed PMID: 17472320. 11: Tashjian RZ, Katarincic JA. Complex elbow instability. J Am Acad Orthop Surg. 2006 May;14(5):278-86. Review. PubMed PMID: 16675621. 12: Bain GI, Ashwood N, Baird R, Unni R. Management of Mason type-III radial head fractures with a titanium prosthesis, ligament repair, and early mobilization. Surgical technique. J Bone Joint Surg Am. 2005 Mar;87 Suppl 1(Pt 1):136-47. Review. PubMed PMID: 15743855. 13: McKee MD, Pugh DM, Wild LM, Schemitsch EH, King GJ. Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. Surgical technique. J Bone Joint Surg Am. 2005 Mar;87 Suppl 1(Pt 1):22-32. Review. PubMed PMID: 15743844. 14: Mehta JA, Bain GI. Posterolateral rotatory instability of the elbow. J Am Acad Orthop Surg. 2004 Nov-Dec;12(6):405-15. Review. PubMed PMID: 15615506.
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Thank you! Return to Upper Extremity Index If you would like to volunteer as an author for the Resident Slide Project or recommend updates to any of the following slides, please send an e-mail to ota@ota.org
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For questions or comments, please send to ota@ota.org