Theatre staff course Mr Lee Van Rensburg March 2012 Elbow fractures Theatre staff course Mr Lee Van Rensburg March 2012

Anatomy Bones Distal Humerus Proximal radius Proximal ulna Radial head   Anatomy Bones Distal Humerus Proximal radius Radial head Proximal ulna Olecranon

Anatomy Joints Hinge – Flex and extend Rotation – Supinate and pronate   Anatomy Joints Hinge – Flex and extend Ulna and trochlea Rotation – Supinate and pronate

Anatomy Joints Hinge (Flexion and extension)   Anatomy Joints Hinge (Flexion and extension) Ulna and trochlea Rotation – Pronation and supination Capitellum and radius

 Proximal ulna shape Greyhen; VOL. 89-B, No. 6, JUNE 2007

Anatomy - Ligaments Medial view Ulnar collateral ligament Lateral view Radial collateral ligament Annular ligament

Anatomy Nerves Ulnar nerve Median nerve Radial nerve

Radiology  Radial head points to capitellum Anterior humeral line Shaft condylar angle ~ 40 degrees

 40 YO Fall Diagnosis? Treatment ?

 23 YO fall Treatment? Diagnosis?

 TBW

42 YO motorcycle NO TBW, needs more stability No Ex Fix in this case  42 YO motorcycle NO TBW, needs more stability No Ex Fix in this case Early ROM Diagnosis ? Treatment ?

 24 YO car roll over, open Treatment ? 2 weeks

65 YO bicycle Treatment ? Diagnosis?   65 YO bicycle Avulsed radial collateral ligament and common extensor origin Treatment ? Diagnosis?

 65 YO bicycle

45 YO Fall steps Removable slab 6 weeks Free ROM  45 YO Fall steps Removable slab 6 weeks Free ROM Radiograph at 6 months

 40 YO Fall Post Reduction EUA Stable full extension What do you see?

 80 YO Fall Don’t be tempted Treatment ?

 74 YO Fall

70 YO Fall Classify ? Treatment ? 9 Proximal At most 2 distal screws  70 YO Fall Classify ? Descriptive Treatment ? What is the problem ? 9 Proximal At most 2 distal screws

 20 YO Classify ? Descriptve Treatment ?

Distal humerus 2 Philosophies

 32 YO 4 months No infection 3 months

External fixators around the elbow  External fixators around the elbow

Minor complications (15%)  Minor complications (15%) Erythema and nonpurulent drainage >5 days, 9% Skin release 6% (reduce tension) Major complications (10%) Purulent pin site drainage in 1% Fixator malalignment 1% Pin loosening in 4% Deep infection 4%. No nerve injuries JSES; May 2008 (Vol. 17, Issue 3, Pages 447-453)

 45 YO RTA

 Questions www.easytrauma.co.uk

 32 YO Fall Classify ? Early ROM Radiograph at 3 Months Treatment ?

Full pronation and supination  32 YO fall Classify ? 6 weeks Full pronation and supination 10⁰ FFD Treatment ? Approach ?