Download Free Medical Traumatic Elbow Instability PowerPoint Presentation

Traumatic Elbow Instability PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

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 : 944 | Downloads : 2

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Traumatic Elbow Instability David Ring MD PhD Updated April 2016
Slide 2-

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
Slide 3-

Elbow Dislocation Usually posterolateral Can dislocate with anterior band of MCL intact Posteromedial pattern Less common Possibly more unstable
Slide 4-

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
Slide 5-

Slight Subluxation “Drop Sign” Management: Avoid varus stress (shoulder abduction) Active flexion Overhead exercises Drop sign After active flexion exercises
Slide 6-

Unstable Simple Elbow Dislocation Uncommon Older women (simple fall) Young men (high-energy)
Slide 7-

Unstable Simple Elbow Dislocation Ligament / muscle reattachment to epicondyles External fixation Cross pinning
Slide 8-

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
Slide 9-

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
Slide 10-

Medial Collateral Ligament Insufficiency Throwing athletes Chronic attenuation Inability to throw 95 mph fastballs
Slide 11-

LCL Insufficiency Recurrent Simple Elbow Dislocation Insufficiency of the lateral collateral ligament Adolescent elbow dislocation Iatrogenic
Slide 12-

Traumatic Elbow Instability Associated with Fractures
Slide 13-

Definition Fracture-dislocation of the elbow Dislocation of the elbow Intra-articular fracture
Slide 14-

Definition Traumatic Elbow Instability Injury that destabilizes the elbow With or without dislocation
Slide 15-

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
Slide 16-

Dislocation vs. Disruption Dislocation Disruption
Slide 17-

Dislocation vs. Disruption Dislocation Disruption
Slide 18-

Dislocation vs. Disruption Dislocation Disruption Ligaments Partially Spared
Slide 19-

Disruption Ligaments Partially Spared
Slide 20-

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
Slide 21-

Posterior Dislocation + Radial Head Fracture
Slide 22-

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
Slide 23-

Posterior Dislocation + Radial Head Fracture 23 patients Excision of radial head and cast INSTABILITY in patients with CORONOID fractures (4 patients)
Slide 24-

Terrible Triad Posterior dislocation Radial head fracture Coronoid fracture
Slide 25-

Terrible Triad Only patients with INSTABILITY had CORONOID fractures (4 patients)
Slide 26-

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
Slide 27-

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.
Slide 28-

ppt slide no 28 content not found
Slide 29-

ppt slide no 29 content not found
Slide 30-

Regan and Morrey Based on single lateral radiograph Type 1: Tip avulsion Type 2: < 50% coronoid height Type 3: > 50% coronoid height
Slide 31-

ppt slide no 31 content not found
Slide 32-

ppt slide no 32 content not found
Slide 33-

ppt slide no 33 content not found
Slide 34-

ppt slide no 34 content not found
Slide 35-

O’Driscoll Classification 1 3 2
Slide 36-

ppt slide no 36 content not found
Slide 37-

ppt slide no 37 content not found
Slide 38-

ppt slide no 38 content not found
Slide 39-

Varus Posteromedial Rotational Injuries Inadequate Treatment
Slide 40-

Olecranon Fracture-Dislocations Anterior (trans-olecranon) fracture-dislocations Posterior (posterior Monteggia) fracture-dislocations
Slide 41-

Anterior (Trans-Olecranon Fracture-Dislocation of the Olecranon
Slide 42-

Anterior (Trans-Olecranon) Fracture-Dislocation of the Olecranon
Slide 43-

POSTERIOR MONTEGGIA TYPE FRACTURE-DISLOCATION Posterior Fracture-Dislocation of the Olecranon
Slide 44-

POSTERIOR MONTEGGIA TYPE FRACTURE-DISLOCATION Posterior Fracture-Dislocation of the Olecranon
Slide 45-

Principles of Treatment Restore contour and dimensions of trochlear notch Contoured dorsal plate Fixation of coronoid Bridge fragmentation
Slide 46-

Treatment Tips Pin the olecranon to the trochlea Consider a temporary external fixator for a complex fracture
Slide 47-

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)
Slide 48-

Coronoid Provisional Fixation Coronoid fixation with plate then reduce and fix olecranon Pin fragments to trochlea Need to immobilize the elbow
Slide 49-

ppt slide no 49 content not found
Slide 50-

ppt slide no 50 content not found
Slide 51-

ppt slide no 51 content not found
Slide 52-

ppt slide no 52 content not found
Slide 53-

ppt slide no 53 content not found
Slide 54-

ppt slide no 54 content not found
Slide 55-

ppt slide no 55 content not found
Slide 56-

ppt slide no 56 content not found
Slide 57-

ppt slide no 57 content not found
Slide 58-

ppt slide no 58 content not found
Slide 59-

ppt slide no 59 content not found
Slide 60-

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.
Slide 61-

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
Slide 62-

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
Slide 63-

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.
Slide 64-

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.
Slide 65-

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
Slide 66-

For questions or comments, please send to ota@ota.org