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©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Trauma  Anatomy   3D  Dislocations   Radial Head  Fractures   Radial Head   Forearm Patterns.

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Presentation on theme: "©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Trauma  Anatomy   3D  Dislocations   Radial Head  Fractures   Radial Head   Forearm Patterns."— Presentation transcript:

1 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Trauma  Anatomy   3D  Dislocations   Radial Head  Fractures   Radial Head   Forearm Patterns   Children  Examining Elbow Radiographs schreibman.info

2 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

3 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

4 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

5 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

6 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

7 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

8 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

9 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

10 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

11 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

12 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

13 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

14 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

15 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

16 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

17 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

18 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

19 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

20 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

21 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

22 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

23 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

24 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

25 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

26 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

27 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

28 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

29 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

30 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

31 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

32 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

33 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

34 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

35 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

36 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

37 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

38 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

39 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy Capitellum [L. small head] ball-shaped ball-shapedTrochlea [Gr. pulley] spool-shaped spool-shaped Radial Head disc-shaped disc-shapedOlecranon [Gr. elbow] ULNA RADIUS TROC CAP HUMERUS HEAD OLEC

40 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

41 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

42 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

43 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

44 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

45 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

46 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

47 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy

48 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy HUMERUS RADIUS CAP ULNA TROC OLECRANON CORONOID ON CORACOID

49 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy HUMERUS RADIUS CAP ULNA TROC OLECRANON CORONOID ON CORONOID

50 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Dislocations LateralView Olecranon & Radial Head  Easy! APView APView Relocated

51 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Dislocations: Parallelism APView Relocated APView Dislocated Parallel Articular Surfaces Parallel Articular Surfaces Lack of Parallelism Lack of Parallelism LateralView Relocated Parallel Articular Surfaces Parallel Articular Surfaces

52 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Dislocations Olecranon & Radial Head  Easy! Radial Head Only  Can be very subtle

53 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Keys to Examining Elbows Radial Head points to Capitellum   on all views   1) 2) 3) 4)

54 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy HUMERUS RADIUS CAP ULNA TROC

55 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy HUMERUS RADIUS CAP TROC Radial Head points to Capitellum

56 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy Radial Head points to Capitellum

57 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy Radial Head points to Capitellum

58 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy Radial Head points to Capitellum

59 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy Radial Head points to Capitellum

60 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy Radial Head points to Capitellum

61 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy Radial Head points to Capitellum

62 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy Radial Head points to Capitellum

63 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy Radial Head points to Capitellum

64 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy Radial Head points to Capitellum

65 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy Radial Head points to Capitellum

66 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy Radial Head points to Capitellum

67 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy Radial Head points to Capitellum

68 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy Radial Head points to Capitellum

69 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy Radial Head points to Capitellum

70 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy Radial Head points to Capitellum

71 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy Radial Head points to Capitellum

72 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy Radial Head points to Capitellum

73 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Anatomy Radial Head points to Capitellum

74 ©Ken L Schreibman, PhD/MD 2010 schreibman.info APLateral Congenital Radial Head Dislocation 4 year-old male No trauma Could not supinate arm Lateral RightLeft

75 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Dislocations Olecranon & Radial Head  Easy! Radial Head Only  Can be very subtle

76 ©Ken L Schreibman, PhD/MD 2010 schreibman.info 10 year-old female APLateral--------- Not a True Lateral True Lateral Monteggia Fracture

77 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Monteggia Fracture ULNA HUMERUS CAP TROC CARPUSCARPUS FALL RADIUS

78 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Monteggia Fracture HUMERUS ULNA CAP TROC CARPUSCARPUS FALL RADIUS

79 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Monteggia Fracture Post Reduction

80 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Monteggia Fracture Giovanni Battista Monteggia (1762-1815)  Greatest Italian Surgeon beginning 19th century Hunter, Peltier, Lund RadioGraphics 2000:20;819-836 l Fx Prox 1 / 3 Ulna l Ant Disloc Rad Head

81 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Monteggia Fracture Bado’s classification of Monteggia fractures Hunter, Peltier, Lund RadioGraphics 2000:20;819-836

82 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Monteggia Fracture

83 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Monteggia Fracture

84 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Forearm Fractures ULNA HUMERUS CAP TROC CARPUSCARPUS FALL RADIUS

85 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Forearm Fractures ULNA HUMERUS CAP TROC CARPUSCARPUS FALL RADIUS : Galeazzi

86 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Riccardo Galeazzi (1866-1952)  Developed Orthopedic Rehab in Italy  Crippled soldiers/children wounded WWI Galeazzi Fracture Hunter, Peltier, Lund RadioGraphics 2000:20;819-836  Fracture Middle-Distal ⅓ Radius  Dislocation of the Distal Radio-Ulnar Joint (DRUJ)

87 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Galeazzi Fracture << Monteggia  Fracture Middle-Distal ⅓ Radius  Dislocation of the Distal Radio-Ulnar Joint (DRUJ)

88 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Monteggia vs Galeazzi: mnemonic HUMERUS ULNA CAP TROC CARPUSCARPUS FALL RADIUS ULNA HUMERUS CAP TROC CARPUSCARPUS FALL RADIUS MU/GRM G U R

89 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Forearm Fractures ULNA HUMERUS CAP TROC CARPUSCARPUS RADIUS : Nightstick Fx

90 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Forearm Fractures : Nightstick Fx Chicago, 1968

91 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Forearm Fractures 2 months later : Nightstick Fx

92 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Both Bone Forearm Fracture ULNA HUMERUS CAP TROC CARPUSCARPUS FALL RADIUS Common in children Can look scary… …but should heal well “if both ends of the bone are in the same room” …but should heal well “if both ends of the bone are in the same room”

93 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Both Bone Forearm Fracture AP View 7 Months Later Lateral View 12 year-old Male

94 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Essex-Lopresti Fracture IOM ULNA HUMERUS CAP TROC CARPUSCARPUS FALL RADIUS

95 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Essex-Lopresti Fracture Peter Gordon Essex-Lopresti (1918-1951)  British Surgeon, Air Borne Div, WWII  Expert on Parachuting Injuries  Classification scheme for Calcaneal Fxs Radial Head Fx w/ Disruption DRUJ  Displaced Rad Head Fx  Examine Wrist Closely Hunter, Peltier, Lund RadioGraphics 2000:20;819-836

96 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Essex-Lopresti Fracture Impacted, Comminuted Radial Head Fracture Impacted, Comminuted Radial Head Fracture Lack of Parallelism Lack of Parallelism

97 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Essex-Lopresti Fracture Impacted, Comminuted Radial Head Fracture Impacted, Comminuted Radial Head Fracture Radial Head Prosthesis

98 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Essex-Lopresti Fracture Lack of Parallelism Lack of Parallelism Parallel articular surfaces Post Radial Head Prosthesis

99 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Keys to Examining Elbows Radial Head points to Capitellum   on all views Fat Pads are your Friend   1) 2) 3) 4)

100 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Fat Pads HUMERUS ULNA CAP RADIUS

101 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Fat Pads ULNA RADIUS HUMERUS Anterior Fad Pad (Coronoid Fossa) Posterior Fad Pad (Olecranon Fossa) Resnick fig22-15 With a radial head fracture:  Bleeding into joint (hemarthrosis)  Elevates the Fat Pads CAP Resnickfig22-16

102 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Fat Pads ULNA RADIUS HUMERUS CAP Normally, can’t see Posterior Fat Pad (tucked in olecranon fossa) Anytime you can see it, indicates it is displaced… probably by hemarthrosis

103 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Fat Pads ULNA RADIUS HUMERUS CAP Normally, can’t see Posterior Fat Pad (tucked in olecranon fossa) Anytime you can see it, indicates it is displaced… probably by hemarthrosis

104 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Keys to Examining Elbows Radial Head points to Capitellum   on all views Fat Pads are your Friend Most Radial Head Fractures are non-displaced and hard to see   Adults = Radial Head Fracture   1) 2) 3) 4)

105 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elevated Fat Pad = Radial Head Fx ULNA RADIUS HUMERUS CAP Lateral AP Oblique

106 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elevated Fat Pad = Radial Head Fx EXTROT

107 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Radial Neck is Outside Joint Capsule Resnick fig22-15 Radial Neck fracture does not cause a hemarthrosis, and does not elevate the fat pads.

108 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Radial Neck is Outside Joint Capsule Resnick fig22-15 No Fat Pad Elevation

109 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Keys to Examining Elbows Radial Head points to Capitellum   on all views Fat Pads are your Friend   Adults = Radial Head Fracture   Children = Supracondylar Fx   1) 2) 3) 4)

110 ©Ken L Schreibman, PhD/MD 2010 schreibman.info AnatomyULNA RADIUS HUMERUS TROC CAP

111 AnatomyULNA RADIUS HUMERUS Articular surfaces unossified at birth Ossify in order C R I T O EC R I T O E Capitellum Rad Head Int (med) Epi Trochlea Olecranon Ext (lat) Epi : Ossification Centers CAP 2 year-old female …..2…..4..6…….8…10..12

112 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Fractures: Children ULNA RADIUS HUMERUS CAP Supracondylar Fracture   60% Elbow Fxs in Children   Subtle  Grossly Displaced

113 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Fractures: Children ULNA RADIUS HUMERUS CAP 2 year-old female Supracondylar Fracture   60% Elbow Fxs in Children   Subtle  Grossly Displaced Right (painful side) Left (normal side)

114 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Fractures: Children Supracondylar Fracture   60% Elbow Fxs in Children   Subtle  Grossly Displaced Supracondylar Fracture   60% Elbow Fxs in Children   Subtle  Grossly Displaced Right (painful side) Left (normal side)

115 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Supracondylar Fracture Right (painful side) Left (normal side) Anterior Humeral Line Should pass thru middle Capitellum

116 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Keys to Examining Elbows Radial Head points to Capitellum   on all views Fat Pads are your Friend   Adults = Radial Head Fracture   Children = Supracondylar Fx Anterior Humeral Line   Should pass thru middle ⅓ Capitellum   1) 2) 3) 4)

117 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Supracondylar Fracture 5 year-old female Day of injury After 2 weeks After 5 weeks

118 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Keys to Examining Elbows Radial Head points to Capitellum   on all views Fat Pads are your Friend   Adults = Radial Head Fracture   Children = Supracondylar Fx (Lateral Condyle Fx) Anterior Humeral Line   Should pass thru middle ⅓ Capitellum   1) 2) 3) 4)

119 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Fractures: Children Lateral Condyle Fracture  2 nd most common pediatric elbow Fx  20% of elbow injuries in children

120 ©Ken L Schreibman, PhD/MD 2010 schreibman.info 6 year-old female Elbow Fractures: Children Lateral Condyle Fracture  2 nd most common pediatric elbow Fx  20% of elbow injuries in children Left (painful side) Right (normal side)

121 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Keys to Examining Elbows Radial Head points to Capitellum   on all views Fat Pads are your Friend   Adults = Radial Head Fracture   Children = Supracondylar Fx (Lateral Condyle Fx) Anterior Humeral Line   Should pass thru middle ⅓ Capitellum When in doubt, get the other side   1) 2) 3) 4)

122 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Fractures: Children C R I T O EC R I T O E Capitellum Rad Head Int (med) Epi Trochlea Olecranon Ext (lat) Epi …..2…..4..6…….8…10..12 C I R T O E 14 year-old male

123 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Elbow Fractures: Children 14 year-old male Left (painful side) Right (normal side) Width of normal growth plate Abnormally widened growth plate Avulsion Medial Epicondyle “Little Leaguer’s Elbow”  Traction common tendon flexor- pronator group  Traction UCL  Result of valgus stress Fall on out- stretched hand Fall on out- stretched hand Violent throwing contractions Violent throwing contractions

124 ©Ken L Schreibman, PhD/MD 2010 schreibman.info Keys to Examining Elbows Radial Head points to Capitellum   on all views Fat Pads are your Friend   Adults = Radial Head Fracture   Children = Supracondylar Fx (Lateral Condyle Fx) Anterior Humeral Line   Should pass thru middle ⅓ Capitellum When in doubt, get the other side   1) 2) 3) 4)


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