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Images
  • summary
  • Etiology
  • Anatomy
  • Presentation
  • Imaging
  • Treatment
  • Techniques
    • ORIF vs replacement of radial head, coronoid ORIF, LCL reconstruction, and possible MCL reconstruction
      • approach
        • posterior skin incision advantageous
          • allows access to both medial and lateral aspect of elbow
          • lower risk of injury to cutaneous nerves
          • more cosmetic
      • technique
        • radial head ORIF vs. arthroplasty
          • radial head ORIF indicated if non comminuted fractures that involve < 40% articular surface
            • 1.5, 2.0, or 2.4mm countersunk screws
            • plate if necessary; 2.0 plates cause minimal loss of motion even when placed on radial neck
            • plate position should be posterolateral
              • safe zone: 90-110 arc from radial styloid to Lister's tubercle with arm in neutral rotation
          • radial head arthroplasty indicated for comminuted radial head fxs (> 3 pieces)
            • implant should articulate 2mm distal to the tip of the coronoid process
            • radial head resection without replacement is NOT indicated in presence of Essex-Lopresti lesion or in ligamentously injured elbows
            • if <25% head damaged or fragments not reconstructable and nonarticulating, can excise fractured portion if elbow stable (rarely indicated)
        • coronoid ORIF
          • can be fixed through radial head defect laterally
          • sutures, suture anchors, screws, or rarely plate fixation.
            • suture passed through 2 drill holes
            • posterior to anterior lag screws if fragment large
            • basal coronoid fxs (rare) fixed with anteromedial or medial plate on proximal ulna
              • FCU split approach preferred for rare isolated coronoid fractures
        • LCL repair
          • usually avulsed from origin on lateral epicondyle
          • reattach with suture anchors or transosseous sutures
            • must be reattached at center of capitellar curvature on lateral epicondyle
          • if MCL is intact, LCL is repaired with forearm in pronation
          • if MCL injured, LCL is repaired with forearm in supination to avoid medial gapping due to overtightening
          • repairs are performed with elbow at 90 degrees of flexion
        • MCL repair
          • indicated if instability on exam after LCL and fracture fixation, especially with extension beyond 30 degrees
          • persistent posteromedial instability following radial head replacement/repair and LCL repair in the setting of a Type I/II coronoid fracture should be managed with MCL repair
      • postoperative
        • elbow fixators - hinged or static
          • consider when instability is noted after complete bone and soft tissue repair
        • immobilization
          • can immobilize elbow in flexion with forearm pronation to provide stability against posterior subluxation
          • if both MCL and LCL were repaired, splint in flexion and neutral rotation
        • rehabilitation
          • initiate active ROM exercises 48 hours after surgery to improve functional outcomes
          • if LCL is repaired, passive elbow motion should occur with the forearm in pronation
          • if MCL is repaired, passive elbow motion should occur with the forearm in supination
          • if both the MCL and LCL are repaired, passive elbow motion should occur with the forearm in neutral 
  • Complications
  • Prognosis
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Trauma | Terrible Triad Injury of Elbow
  • Trauma
  • - Terrible Triad Injury of Elbow
23:34 min
10/18/2019
2056 plays
4.4
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