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Elbow Injuries PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Elbow Injuries” by DR R B Kalia.

This medical PowerPoint presentation is about elbow injuries. Elbow injuries can occur due to a variety of reasons, such as overuse, trauma, or sports-related injuries.

Some common elbow injuries include Tennis elbow, Golfers elbow, Elbow sprain, Elbow dislocation, and Fractures.

Tags : Elbow Injuries, Tennis elbow, Golfers elbow, Elbow sprain, Elbow dislocation, and Fractures, Orthopedics, Orthopedics PowerPoint presentation

Published on : May 29, 2023 | Views : 642 | Downloads : 1

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Slide 1-

Elbow Injuries DR R B Kalia, Additional Professor Department of Orthopaedics.
Slide 2-

Objectives Understand the spectrum of Disease Common Paediatric fractures Common Adult Injuries Develop evaluation of elbow injuries Diagnose and choose treatment
Slide 3-

Introduction “Pity the young surgeon whose first case is a fracture around the elbow”
Slide 4-

Question 1- Identify this injury in a 3 years old boy Dislocation elbow Supracondylar fracture Humerus Separation distal humeral physis Lateral condyle Humerus fracture
Slide 5-

Introduction- Elbow fractures 5% to 10% of all fractures in children are fractures of the elbow. High potential for complications-difficult to manage. Supracondylar fractures- 50% to 70% of all elbow fractures Frequently in children between the ages of 3- 10 years.
Slide 6-

CRITOE Capitellum (2years) Radius(4years) Internal (or medial) epicondyle(6years) Trochlea(8 years) Olecranon(10 years) External (or lateral) epicondyle(12 years)
Slide 7-

Common Fractures The supracondylar Humerus The transphyseal distal Humerus The lateral humeral condyle The medial humeral epicondyle (often associated with elbow dislocation)
Slide 8-

Uncommon FRACTURES The capitellum Coronoid Medial condyle Lateral epicondyle Intracondylar or T-condylar fractures
Slide 9-

Supracondylar Fractures of the Humerus Devastating long-term complications. Anteriorly- the brachial artery and median nerve Laterally, the radial nerve crosses The ulnar nerve passes behind the medial epicondyle
Slide 10-

ANATOMY Coronoid Fossa Olecranon Fossa
Slide 11-

Extension type 97.7% Flexion type 2.3% In extension type fracture line runs upwards and backwards And in flexion type it runs downwards and backwards Classification -Supracondylar fracture
Slide 12-

Extension Type Fr When forced into hyperextension, the olecranon can act as a fulcrum through which an extension force can propagate a fracture across the medial and lateral columns
Slide 13-

Flexion Supraconylar Fr A posteriorly applied force with the elbow in flexion creates a flexion-type supracondylar humeral fracture (arrow).
Slide 14-

CLASSIFICATION-Gartland Classification After initial classification as either extension or flexion injuries. Classified according to the amount of radiographic displacement.
Slide 15-

Q 2- How Do You Classify? Flexion/Extension? Gartland I,II,III?
Slide 16-

How Do You Classify? Flexion/Extension? Gartland I,II,III?
Slide 17-

RADIOGRAPHIC FINDINGS The elbow is painful and difficult to move True AP and lateral radiographs of fractures are required “ Bad x-rays lead to bad decisions.”
Slide 18-

TREATMENT - Goal “Avoid catastrophes” Vascular compromise Compartment syndrome “minimize embarrassments” cubitus varus, iatrogenic nerve palsies
Slide 19-

Emergency Treatment Immobilized - simple splint(radiolucent splint). Contraindication- Ischemic hand or tented skin, Radiographs should be obtained before splinting, or should be used.
Slide 20-

If distal extremity is initially ischemic? Align the fracture fragments Re evaluaie vascularity Avoid Flexion >90 degrees
Slide 21-

Treatment of Nondisplaced Fractures ? Long-arm cast immobilization for 3 weeks . Radiographs are repeated at one week –Check
Slide 22-

Extension Gartland III- Treatment?
Slide 23-

Treatment of Displaced Fractures (types II and III). Require reduction. Reduction can be accomplished in closed fashion. Maintaining the reduction? Cast immobilization, traction, and percutaneous pin fixation. Adequate closed reduction cannot be achieved- open reduction pinning
Slide 24-

CR and K-wire fixation
Slide 25-

Per op Images
Slide 26-

Healed fracture at 4 weeks
Slide 27-

Collateral circulation
Slide 28-

Viable hand with abnormal pulses ? Close observation. Unidentified vascular pathology-thrombus formation- an ischemic limb. Pulse oximetry- valuable tool after closed reduction and pinning. Pulseless, viable limb-ischemic- arteriography and thrombolytic therapy
Slide 29-

COMPLICATIONS Early complications Vascular injury Peripheral nerve palsies Volkmann's ischemia (compartment syndrome). Late complications Malunion Stiffness Myositis ossificans.
Slide 30-

Vascular Injury-Spectrum? A diminished pulse/Without a pulse/With an ischemic limb. Complete transection of the brachial artery An intimal tear Compression either between the fracture fragments or over the anteriorly displaced fragment. Indirect injury is usually the result of compression due to the swelling.
Slide 31-

Management Thorough assessment of the skin and neurologic status If ischemic- manipulated into an extended position. If fails to provide distal circulation Closed reduction and pinning Reduction of the fracture frequently restores the circulation
Slide 32-

Peripheral Nerve Injury 10% to 15% of supracondylar humeral fractures. The anterior interosseous nerve is the most commonly injured nerve with extension-type supracondylar fractures Usually recover spontaneously If within 8 to 12 weeks function is not returning-NCV/EMG nerve has not been transected. Transected- reanastomosis with grafting or tendon transfers
Slide 33-

Compartment Syndrome? Best managed by closed reduction and pinning. A fasciotomy is essential to decompress the increased pressure Splinting and active and passive range-of-motion exercises -essential to maintain joint mobility until function returns.
Slide 34-

Volkmann's Ischemic Contracture (Chr Compartment Syndrome) Ischemic paralysis and contracture of the muscles of the forearm and hand Primarily resulted from obstruction of arterial blood flow, resulting in death of the muscles which get replaced by fibrous tissue
Slide 35-

Malunion: Cubitus Varus and Cubitus Valgus Posteromedially displaced fractures tend to develop Cubitus varus angulation-more common Posterolaterally displaced fractures tend to develop valgus deviation.
Slide 36-

T/T -Osteotomy and k-wire fixation
Slide 37-

Lateral Condyle Fractures These fractures are the second most common children’s elbow fracture to need operative treatment. (1) The fracture heals slowly. (2) Late deformity can occur. (3) Non-union is a recognized complication
Slide 38-

Treatment Undisplaced lateral condyle- Long arm cast. Displaced fractures – stabilized by Open reduction K-wire fixation.
Slide 39-

Complete Articular Fractures of the DistalHumerus—T-Fracture
Slide 40-

Radial Neck 30◦ of angulation can be treated conservatively provided there is no displacement- Long arm cast
Slide 41-

Displaced fractures ? Need to be reduced but closed reduction can be difficult
Slide 42-

Post Op
Slide 43-

Injuries of Adult Elbow
Slide 44-

Spectrum Olecranon & Proximal Ulnar Fractures Radial Head Fractures Elbow Dislocations
Slide 45-

Anatomy-Olecranon Fractures- The triceps attaches to the olecranon Principle force which displaces the fracture.
Slide 46-

Symptoms H/O Trauma: Direct/Indirect Pain Swelling Inability to extend against gravity Tenderness
Slide 47-

Signs Swelling Contusion Gap at fracture site Extension lag
Slide 48-

Mayo Classification Type 1: Minimally displaced-Nonoperative Type 2: Displaced without ulnohumeral instability-Surgery Type 3: Displaced with ulnohumeral instability-Surgery
Slide 49-

OR&IF- Tension band wiring
Slide 50-

Post Op
Slide 51-

Complex fractures or fracture-dislocations Tension band wire constructs can fail- Plating is the choice
Slide 52-

RADIAL HEAD FRACTURES-Mechanism Fractures when it collides with the capitellum Fall onto the outstretched hand
Slide 53-

Classification- Mason Type 1- Nondisplaced fractures- nonoperative treatment Type 2- Displaced fractures involving part of the radial head- Screws Type 3- comminuted fractures -excision
Slide 54-

Type 2
Slide 55-

SIMPLE ELBOW DISLOCATIONS Stable after manipulative reduction. Acute redislocations and chronic recurrent dislocations are uncommon. Mobilization of the elbow within 2 weeks results in less stiffness and pain
Slide 56-

Question 1- Identify this injury in a 3 years old boy? Dislocation elbow Supracondylar fracture Humerus Separation distal humeral physis Lateral condyle Humerus fracture
Slide 57-

Questions?