Complex Elbow Injuries

•

15 recomendaciones•4,444 vistas

Summary of complex elbow injuries involving the radial head presented at American Association for Hand Surgery by Adam Watts from Wrightington Hospital, UK

Salud y medicina

Complex elbow injuries
involving the radial head
Adam C Watts
Consultant Elbow and Upper Limb Surgeon, Wrightington Hospital
Visiting Professor, Manchester University
1

www.wrightington.com
Fracture Dislocations
Recognisable patterns of injury
Management plan based on anatomical principles
Consider “hidden” injury
3

$www.wrightington.com Elbow fracture dislocations 1.Posterior rotatory a.pronation lateral rotation b.pronation medial rotation 2.Trans-olecranon a.extension b.flexion 3.Longitudinal 4$

www.wrightington.com
Posterior lateral rotation
Terrible triad
5

www.wrightington.com
Terrible Triad algorithm
6

www.wrightington.com
Terrible Triad algorithm
Restore coronoid
6

www.wrightington.com
Terrible Triad algorithm
Restore coronoid
Restore radial head
6

www.wrightington.com
Terrible Triad algorithm
Restore coronoid
Restore radial head
Restore lateral soft tissue restraints
6

www.wrightington.com
Terrible Triad algorithm
Restore coronoid
Restore radial head
Restore lateral soft tissue restraints
Restore medial soft tissue if still unstable
6

www.wrightington.com
8
O’Driscoll Classification
1
2
3
from Ring et al.

www.wrightington.com
Does the coronoid need to be
fixed?
Cohort study of 14 consecutive patients (Level 4)
2 Regan-Morrey type I, 12 type 2
No coronoid fixation - Min f/u 24 months
Mean arc of motion 123°
DASH 14
9

www.wrightington.com
How do we manage the radial
head?
11

www.wrightington.com
Radial Head ORIF
12

www.wrightington.com
Intracapsular Fracture
14

www.wrightington.com
Fix or Replace?
No difference in ROM (Level 4)
ORIF more likely to be unstable
33% risk of arthrosis with arthroplasty
Equivalent re-operation rates
17

www.wrightington.com
19
Posterior medial rotation
Posteromedial rotatory instability

$www.wrightington.com 21 Transolecranon Monteggia Fracture Dislocations Proximal ulna fracture with dislocation of radial head from radiocapitellar joint and proximal radioulnar joint$

$www.wrightington.com Bado Classification Anterior Posterior Lateral Radial diaphyseal fracture 22$

www.wrightington.com
Jupiter Classification of Type II
Fractures
IIa Coronoid level
IIb Metaphyseal/Diaphyseal
junction
IIc Distal to coronoid
IId Fracture extending to
distal 1/2 ulna
23

$www.wrightington.com Ring Classification Type I Apex anterior diaphyseal ulna fracture with anterolateral dislocation of radiocapitellar and PRUJ Type II Metaphyseal buckle fractures with anterolateral radiocapitellar dislocation (paediatric only) Type III Apex posterior ulna fractures with posterior dislocation radiocapitellar joint 24$

www.wrightington.com
Aims of treatment
Restoration of normal ulna alignment
Restoration of elbow stability
coronoid buttress
radial head
lateral ligament complex
25

www.wrightington.com
Jupiter IIb, Ring III
29

www.wrightington.com
31
Jupiter IIa, Ring III

www.wrightington.com
39
Longitudinal -
Essex-Lopresti

www.wrightington.com
“Hidden Injury” - IOM
42

www.wrightington.com
Tightrope Reconstruction
47

www.wrightington.com
Bone-ligament-bone graft
49

www.wrightington.com
Ligament Augmentation and
Reconstruction System (LARS)
Polyester rope
Ultimate stress 2600N
Residual Strain at 2500N = 1.5%
Stiffness = 209N/mm (cf 129 native IOM)
No damage after 5 million cycles
52

www.wrightington.com
Experience to date
15 Procedures (chronic injuries) min follow-up 18
months
1 persistent axial instability - revised to OBF
No other recurrent proximal migration
Mean DASH improved 77 to 41/100
54

$www.wrightington.com Elbow fracture dislocations 1.Posterior rotatory a.pronation lateral rotation b.pronation medial rotation 2.Trans-olecranon a.extension b.flexion 3.Longitudinal 55$

$www.wrightington.com Elbow fracture dislocations 1.Posterior rotatory a.pronation lateral rotation b.pronation medial rotation 2.Trans-olecranon a.extension b.flexion 3.Longitudinal 55 Terrible Triad$

Más contenido relacionado

La actualidad más candente

Hand Fractures and DislocationsAdam Watts

Rare scapular injuriesCHIRAGVTHAKKARCVT

Essex-Lopresti Longitudinal Instability of the ForearmAdam Watts

Upper Extremity Trauma Wrist complete MSK Radiology Lecture Radiology Made Easy

Complex elbow injury 2013Sumroeng Neti

Terrible Triadwashingtonortho

ACJ revision surgery 2017Lennard Funk

KNEE RECON KADER 2022.pdfProfessor Deiary Kader

Upper Extremity Trauma MSK Radiology Lecture Radiology Made Easy

PCL, PLC, Knee DislocationProfessor Deiary Kader

Bioprogessive therapy 3 /certified fixed orthodontic courses by Indian dental...Indian dental academy

Distal Humeral Fractures – How to Fix Them, with Correlation with EvidenceAshMoaveni

AC SeparationsAlan M. Hirahara, M.D., FRCSC

Fixed functional appliancesRakhi Bharat

Acromioclavicular joint injuryKanokkorn Navamajiti

$Acetabular fracture Power Point$ $Acetabular fracture Power Point$

Acetabular fracture Power PointTodd Peterson

Bio progressive therapy Mechanics For Class II Div IIIndian dental academy

The Knee Consultation Made Easy for GP Doctors (Nuffield/ Newcastle)Professor Deiary Kader

Spinal immobilisationAlan Batt

$fractures of hand bones$ $fractures of hand bones$

fractures of hand bonesSumer Yadav

La actualidad más candente (20)

Hand Fractures and Dislocations

Rare scapular injuries

Essex-Lopresti Longitudinal Instability of the Forearm

Upper Extremity Trauma Wrist complete MSK Radiology Lecture

Complex elbow injury 2013

Terrible Triad

ACJ revision surgery 2017

KNEE RECON KADER 2022.pdf

Upper Extremity Trauma MSK Radiology Lecture

PCL, PLC, Knee Dislocation

Bioprogessive therapy 3 /certified fixed orthodontic courses by Indian dental...

Distal Humeral Fractures – How to Fix Them, with Correlation with Evidence

AC Separations

Fixed functional appliances

Acromioclavicular joint injury

$Acetabular fracture Power Point$ $Acetabular fracture Power Point$

Acetabular fracture Power Point

Bio progressive therapy Mechanics For Class II Div II

The Knee Consultation Made Easy for GP Doctors (Nuffield/ Newcastle)

Spinal immobilisation

$fractures of hand bones$ $fractures of hand bones$

fractures of hand bones

Destacado

BESS Ian Kelly Prize Winner 2016Adam Watts

Mac april 2015Adam Watts

BESS 2015 elbow reviewAdam Watts

Sports injuries wrist iaocAdam Watts

$Monteggia fracture dislocation in chldren$ $Monteggia fracture dislocation in chldren$

Monteggia fracture dislocation in chldrenHamid Hejrati

Elbow trauma & infectionmrinal joshi

Elbow sports injuriesAaron Venouziou

Imaging anatomy dislocation of the elbowAkram Jaffar

Distal Clavicle Fractures washingtonortho

Surgical approaches to the elbowRem Kulung

$Radial head fracture$ $Radial head fracture$

Radial head fractureKrunal Patel

$Monteggia fracture dislocation_UTSAV$ $Monteggia fracture dislocation_UTSAV$

Monteggia fracture dislocation_UTSAVUtsav Agrawal

Destacado (12)

BESS Ian Kelly Prize Winner 2016

Mac april 2015

BESS 2015 elbow review

Sports injuries wrist iaoc

$Monteggia fracture dislocation in chldren$ $Monteggia fracture dislocation in chldren$

Monteggia fracture dislocation in chldren

Elbow trauma & infection

Elbow sports injuries

Imaging anatomy dislocation of the elbow

Distal Clavicle Fractures

Surgical approaches to the elbow

$Radial head fracture$ $Radial head fracture$

Radial head fracture

$Monteggia fracture dislocation_UTSAV$ $Monteggia fracture dislocation_UTSAV$

Monteggia fracture dislocation_UTSAV

Similar a Complex Elbow Injuries

Monteggia pptdrsiddharthdubey

$Clavicle fractures&acromio clavicular joint injuries$ $Clavicle fractures&acromio clavicular joint injuries$

Clavicle fractures&acromio clavicular joint injuriesmadhavigopalrao

$Osteosynthesis a physiological way of managing Hangman’s fracture$ $Osteosynthesis a physiological way of managing Hangman’s fracture$

Osteosynthesis a physiological way of managing Hangman’s fractureApollo Hospitals

Shoulder Instability Sports - Decision MakingLennard Funk

$Monteggia fracture-Dislocation reference-appleys,maheshwari,rockwood$ $Monteggia fracture-Dislocation reference-appleys,maheshwari,rockwood$

Monteggia fracture-Dislocation reference-appleys,maheshwari,rockwoodemillewin

Cervical Spine Injury.pptxAbrahamEmes

$Distal radius fracture$ $Distal radius fracture$

Distal radius fractureBarun Patel

AC Joint SeparationTodd Peterson

$Seminar on monteggia fracture AND TYPES.pptx$ $Seminar on monteggia fracture AND TYPES.pptx$

Seminar on monteggia fracture AND TYPES.pptxSumitKumar108462

$Galeazzi fracture dislocation$ $Galeazzi fracture dislocation$

Galeazzi fracture dislocationMd Ashiqur Rahman

Fatima Al Ghaithi Case Serise March 2ndEM OMSB

Fractures of scapulaMd Ashiqur Rahman

Fractures Of The Distal Radiusnavigator13

Carpal Fracturesjfreshour

$Important radiological classification of fracture and AVN$ $Important radiological classification of fracture and AVN$

Important radiological classification of fracture and AVNDr pradeep Kumar

$Supracondylar fracture of the humerus$ $Supracondylar fracture of the humerus$

Supracondylar fracture of the humerusSantosh Batajoo

$supracondylarfractureofthehumerus-180125165039.pdf$ $supracondylarfractureofthehumerus-180125165039.pdf$

supracondylarfractureofthehumerus-180125165039.pdfSHARONMARIASUNNY

paediatric injuries around the elbow. yashavardhan yashu

DISTAL END RADIUS FRACTURE vashisth narayan

MONTEGGIA FRACTURES CLASSIFICATIONS.pptxWailAggoun

Similar a Complex Elbow Injuries (20)

Monteggia ppt

$Clavicle fractures&acromio clavicular joint injuries$ $Clavicle fractures&acromio clavicular joint injuries$

Clavicle fractures&acromio clavicular joint injuries

$Osteosynthesis a physiological way of managing Hangman’s fracture$ $Osteosynthesis a physiological way of managing Hangman’s fracture$

Osteosynthesis a physiological way of managing Hangman’s fracture

Shoulder Instability Sports - Decision Making

$Monteggia fracture-Dislocation reference-appleys,maheshwari,rockwood$ $Monteggia fracture-Dislocation reference-appleys,maheshwari,rockwood$

Monteggia fracture-Dislocation reference-appleys,maheshwari,rockwood

Cervical Spine Injury.pptx

$Distal radius fracture$ $Distal radius fracture$

Distal radius fracture

AC Joint Separation

$Seminar on monteggia fracture AND TYPES.pptx$ $Seminar on monteggia fracture AND TYPES.pptx$

Seminar on monteggia fracture AND TYPES.pptx

$Galeazzi fracture dislocation$ $Galeazzi fracture dislocation$

Galeazzi fracture dislocation

Fatima Al Ghaithi Case Serise March 2nd

Fractures of scapula

Fractures Of The Distal Radius

Carpal Fractures

$Important radiological classification of fracture and AVN$ $Important radiological classification of fracture and AVN$

Important radiological classification of fracture and AVN

$Supracondylar fracture of the humerus$ $Supracondylar fracture of the humerus$

Supracondylar fracture of the humerus

$supracondylarfractureofthehumerus-180125165039.pdf$ $supracondylarfractureofthehumerus-180125165039.pdf$

supracondylarfractureofthehumerus-180125165039.pdf

paediatric injuries around the elbow.

DISTAL END RADIUS FRACTURE

MONTEGGIA FRACTURES CLASSIFICATIONS.pptx

Último

Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...Call Girls in Nagpur High Profile

The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...chandars293

Call Girls Horamavu WhatsApp Number 7001035870 Meeting With Bangalore Escortsvidya singh

(Rocky) Jaipur Call Girl - 09521753030 Escorts Service 50% Off with Cash ON D...indiancallgirl4rent

Russian Escorts Girls Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls DelhiAlinaDevecerski

Lucknow Call girls - 8800925952 - 24x7 service with hotel roomdiscovermytutordmt

Call Girls Mumbai Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora

Call Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora

💎VVIP Kolkata Call Girls Parganas🩱7001035870🩱Independent Girl ( Ac Rooms Avai...Taniya Sharma

Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any TimeCall Girls Delhi

Call Girls Jabalpur Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora

Call Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls Jaipurparulsinha

Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora

Call Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora

Top Rated Hyderabad Call Girls Erragadda ⟟ 6297143586 ⟟ Call Me For Genuine ...chandars293

(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...Taniya Sharma

VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋TANUJA PANDEY

Call Girls Bareilly Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora

Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora

Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...aartirawatdelhi

Complex Elbow Injuries

1. Complex elbow injuries involving the radial head Adam C Watts Consultant Elbow and Upper Limb Surgeon, Wrightington Hospital Visiting Professor, Manchester University 1

2. www.wrightington.com 92 F Active 2

3. www.wrightington.com Fracture Dislocations Recognisable patterns of injury Management plan based on anatomical principles Consider “hidden” injury 3

4. www.wrightington.com Elbow fracture dislocations 1.Posterior rotatory a.pronation lateral rotation b.pronation medial rotation 2.Trans-olecranon a.extension b.flexion 3.Longitudinal 4

5. www.wrightington.com Elbow fracture dislocations 1.Posterior rotatory a.pronation lateral rotation b.pronation medial rotation 2.Trans-olecranon a.extension b.flexion 3.Longitudinal 4

6. www.wrightington.com Elbow fracture dislocations 1.Posterior rotatory a.pronation lateral rotation b.pronation medial rotation 2.Trans-olecranon a.extension b.flexion 3.Longitudinal 4

7. www.wrightington.com Elbow fracture dislocations 1.Posterior rotatory a.pronation lateral rotation b.pronation medial rotation 2.Trans-olecranon a.extension b.flexion 3.Longitudinal 4

8. www.wrightington.com Elbow fracture dislocations 1.Posterior rotatory a.pronation lateral rotation b.pronation medial rotation 2.Trans-olecranon a.extension b.flexion 3.Longitudinal 4

9. www.wrightington.com Posterior lateral rotation Terrible triad 5

10. www.wrightington.com Terrible Triad algorithm 6

11. www.wrightington.com Terrible Triad algorithm Restore coronoid 6

12. www.wrightington.com Terrible Triad algorithm Restore coronoid Restore radial head 6

13. www.wrightington.com Terrible Triad algorithm Restore coronoid Restore radial head Restore lateral soft tissue restraints 6

14. www.wrightington.com Terrible Triad algorithm Restore coronoid Restore radial head Restore lateral soft tissue restraints Restore medial soft tissue if still unstable 6

15. www.wrightington.com Terrible Triad algorithm Restore coronoid Restore radial head Restore lateral soft tissue restraints Restore medial soft tissue if still unstable Apply hinged ex-fix 6

16. www.wrightington.com 7

17. www.wrightington.com 8 O’Driscoll Classification 1 2 3 from Ring et al.

18. www.wrightington.com 8 O’Driscoll Classification 1 2 3 from Ring et al.

19. www.wrightington.com Does the coronoid need to be fixed? Cohort study of 14 consecutive patients (Level 4) 2 Regan-Morrey type I, 12 type 2 No coronoid fixation - Min f/u 24 months Mean arc of motion 123° DASH 14 9

20. www.wrightington.com 10

21. www.wrightington.com 10

22. www.wrightington.com How do we manage the radial head? 11

23. www.wrightington.com Radial Head ORIF 12

24. www.wrightington.com 13

25. www.wrightington.com Intracapsular Fracture 14

26. www.wrightington.com Intracapsular Fracture 14

27. www.wrightington.com 15

28. www.wrightington.com 16

29. www.wrightington.com Fix or Replace? No difference in ROM (Level 4) ORIF more likely to be unstable 33% risk of arthrosis with arthroplasty Equivalent re-operation rates 17

30. www.wrightington.com “Hidden” injury 18

31. www.wrightington.com “Hidden” injury 18

32. www.wrightington.com “Hidden” injury 18

33. www.wrightington.com 19 Posterior medial rotation Posteromedial rotatory instability

34. www.wrightington.com 20

35. www.wrightington.com 20

36. www.wrightington.com 21 Transolecranon Monteggia Fracture Dislocations Proximal ulna fracture with dislocation of radial head from radiocapitellar joint and proximal radioulnar joint

37. www.wrightington.com Bado Classification Anterior Posterior Lateral Radial diaphyseal fracture 22

38. www.wrightington.com Jupiter Classification of Type II Fractures IIa Coronoid level IIb Metaphyseal/Diaphyseal junction IIc Distal to coronoid IId Fracture extending to distal 1/2 ulna 23

39. www.wrightington.com Ring Classification Type I Apex anterior diaphyseal ulna fracture with anterolateral dislocation of radiocapitellar and PRUJ Type II Metaphyseal buckle fractures with anterolateral radiocapitellar dislocation (paediatric only) Type III Apex posterior ulna fractures with posterior dislocation radiocapitellar joint 24

40. www.wrightington.com Aims of treatment Restoration of normal ulna alignment Restoration of elbow stability coronoid buttress radial head lateral ligament complex 25

41. www.wrightington.com Bado I, Ring I 26

42. www.wrightington.com 27

43. www.wrightington.com 27

44. www.wrightington.com 27

45. www.wrightington.com 28

46. www.wrightington.com Jupiter IIb, Ring III 29

47. www.wrightington.com 30

48. www.wrightington.com 31 Jupiter IIa, Ring III

49. www.wrightington.com 32

50. www.wrightington.com 33

51. www.wrightington.com 34

52. www.wrightington.com 35

53. www.wrightington.com 36

54. www.wrightington.com 37

55. www.wrightington.com 37

56. www.wrightington.com 37

57. www.wrightington.com 38

58. www.wrightington.com 38

59. www.wrightington.com 38

60. www.wrightington.com 39 Longitudinal - Essex-Lopresti

61. www.wrightington.com 40

62. www.wrightington.com 41

63. www.wrightington.com 41

64. www.wrightington.com “Hidden Injury” - IOM 42

65. www.wrightington.com 43

66. www.wrightington.com 43

67. www.wrightington.com 43

68. www.wrightington.com 43

69. www.wrightington.com 43

70. www.wrightington.com 44

71. www.wrightington.com 45

72. www.wrightington.com 46

73. www.wrightington.com Tightrope Reconstruction 47

74. www.wrightington.com 48

75. www.wrightington.com Bone-ligament-bone graft 49

76. www.wrightington.com 50

77. www.wrightington.com 51

78. www.wrightington.com Ligament Augmentation and Reconstruction System (LARS) Polyester rope Ultimate stress 2600N Residual Strain at 2500N = 1.5% Stiffness = 209N/mm (cf 129 native IOM) No damage after 5 million cycles 52

79. www.wrightington.com 53

80. www.wrightington.com 53

81. www.wrightington.com 53

82. www.wrightington.com 53

83. www.wrightington.com 53

84. www.wrightington.com 53

85. www.wrightington.com Experience to date 15 Procedures (chronic injuries) min follow-up 18 months 1 persistent axial instability - revised to OBF No other recurrent proximal migration Mean DASH improved 77 to 41/100 54

86. www.wrightington.com Elbow fracture dislocations 1.Posterior rotatory a.pronation lateral rotation b.pronation medial rotation 2.Trans-olecranon a.extension b.flexion 3.Longitudinal 55

87. www.wrightington.com Elbow fracture dislocations 1.Posterior rotatory a.pronation lateral rotation b.pronation medial rotation 2.Trans-olecranon a.extension b.flexion 3.Longitudinal 55 Terrible Triad

88. www.wrightington.com Elbow fracture dislocations 1.Posterior rotatory a.pronation lateral rotation b.pronation medial rotation 2.Trans-olecranon a.extension b.flexion 3.Longitudinal 55 Terrible Triad PMRI

89. www.wrightington.com Elbow fracture dislocations 1.Posterior rotatory a.pronation lateral rotation b.pronation medial rotation 2.Trans-olecranon a.extension b.flexion 3.Longitudinal 55 Terrible Triad PMRI Ring Type 1

90. www.wrightington.com Elbow fracture dislocations 1.Posterior rotatory a.pronation lateral rotation b.pronation medial rotation 2.Trans-olecranon a.extension b.flexion 3.Longitudinal 55 Terrible Triad PMRI Ring Type 1 Ring Type 3

91. www.wrightington.com Elbow fracture dislocations 1.Posterior rotatory a.pronation lateral rotation b.pronation medial rotation 2.Trans-olecranon a.extension b.flexion 3.Longitudinal 55 Terrible Triad PMRI Ring Type 1 Ring Type 3 Essex-Lopresti

92. www.wrightington.com 92 F Active 56

93. www.wrightington.com 57

94. www.wrightington.com 58

95. www.wrightington.com 59