mohd_afiq_izzuddin_b._rossli_1001336000_543._15-16(2)

8/17/2019 Mohd_Afiq_Izzuddin_b._Rossli_1001336000_543._15-16(2)

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Injury around the Elbow

Mohamad Afq Izzuddin

1001336000Group 3


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Learnin out!ome• "e#!ribe and di$erentiate the !lini!al %eature# o% the %ra!ture

di#lo!ation o% the elbow

• Ma&e a diano#i# and a li#t o% di$erential diano#e# by analy#i# o%me!hani#m o% injury' !lini!al fndin# in hi#tory and phy#i!ale(amination o% the %ra!ture di#lo!ation o% the elbow

• )ele!t appropriate in*e#tiation and interpret to !onfrm thediano#i#' to e*aluate the #e*erity and #tability o% the %ra!turedi#lo!ation o% the elbow+ %orearm,

• -la##i%y the %ra!ture di#lo!ation o% the elbow ba#ed on the !lini!alfndin# and re#ult o% in*e#tiation#,

• .lan the pro*i#ional manaement o% the %ra!ture di#lo!ation o% theelbow

• "i#!u## the defniti*e manaement# and treatment option#

depend on the !la##if!ation# and type o% the %ra!ture di#lo!ationo% the elbow,

• "i#!u## the !ompli!ation# o% the %ra!ture di#lo!ation o% the elbowand pre*ention,

• "i#!u## /ol&mann# i#!haemia and !ontra!ture,

•

"i#!u## the role o% phy#iotherapy and o!!upational therapy %orrehabilitation,


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Anatomy around elbow

one o% elbow

1, "i#tal part o% 2umeru#

, 4adiu#3, 5lna


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he elbow joint i# a modifed hine joint' that ha*e3 #eparate arti!ulation#7

1, 5lnotro!hlear89le(ion:E(ten#ion;, 4ado!apitellar8rotation;3, .ro(imal radioulnar8rotation;


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Ligaments

1< radial !ollateral li,

< anular li, =% radiu#

3< ulnar !ollateral li,>< tran#*er#e li,


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)!enario

• A 6?


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Injury around the Elbow8"d(;

1, "i#tal 2umeru# %ra!ture

, 2ead o% radiu# %ra!ture#

3, 4adial ne!& %ra!ture#>, -apitulum 9ra!ture

?, =le!ranon pro!e## %ra!ture#

6, "i#lo!ation o% Elbow joint


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1; "i#tal 2umeru# 9ra!ture

Mechanism of Injury

• 9ra!ture o% di#tal humeru# are !ommonly due tohih


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A=


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• ype 7 Intra


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• ype -7 Intra!omminution;


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-ompli!ation#

Early complications:

• /a#!ular injury

• @er*e injury

• Mal


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In*e#tiation

B


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reatment

Displaced Fracture• =pen 4edu!tion and internal 9i(ation are the treatment o%

!hoi!e,

• o et the ood e(po#ure o% the joint' intra


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; 4adial head %ra!ture#

Mechanism of Injury

• A %aal on the out#tret!hed hand with elbow %ullye(tended and %orearm are pronated !au#e# theimpa!tion o% radial head aain#t the !apitulum

• he arti!ular !artilae o% !apitulum may be brui#ed or!hipped,

• 4adial head' #ometime# !an al#o be %ra!tured durinelbow di#lo!ation,

• hi# %ra!ture !an be mi##ed' but tenderne## o*er

radial head and pain on pronation+#upination #hould#ue#t the diano#i#


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Clinical Features:

1, )wellin : rui#e#

, Limited raned o% mo*ement

3, A!ti*e fner e(ten#ion>, 9orearm+intero##i membrane tenderne##

?, ri#t tenderne##

•. hi# %ra!ture !an be mi##ed' but tenderne## o*erradial head and pain on pronation+#upination#hould #ue#t the diano#i#


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Mason classication

• ype I7 An undi#pla!ed *erti!al #plit inthe radial head

• ype II7 A di#pla!ed #inle %ramento% the head

• ype III7 he head bro&en into #e*eral%rament# 8!omminuted;,


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Ma#on# -la##if!ation


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reatment

Undisplaced Fracture:

• Anale#i! with a#piration o% haematoma %or the painrelie*e,

• hen' the arm i# held in !ollar : !u$ %or 3 wee,

• A!ti*e e(ion' e(ten#ion and rotation are en!ouraed,

Displaced Fracture:

Indi!ation %or open redu!tion : Internal 9i(ation7

• Mason type II: with the di#pla!ed head o% radiu#,Lare %rament H mm

• Mason type III: where =4I9 %ea#ible, 8H3di#pla!ement may ha*e poor out!ome;


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3; 4adial ne!& %ra!ture#

Mechanism of Injury• A %all on the out#tret!hed hand %or!e# the

elbow into *alu# and pu#he# the radial

head aain#t the !apitulum,

• In !hildren the bone %ra!ture# throuh the

ne!& o% the radiu# are more !ommon,e!au#e radial head in !hildren are mainly!artilainou#,


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reatment

• In Adult#' di#pla!ed %ra!ture o% thene!& o% radiu# may need openredu!tion,

• Mini


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>; -apitulum 9ra!ture

Mechanism of Injury

• hi# i# a rare arti!ular %ra!ture whi!h o!!ur# only inadult#,

• .atient %all on the hand' with elbow !ommonly e(tended,

• he anterior part o% !apitulum i# #heared o$ anddi#pla!ed pro(imally,

Clinical Features

•

9ullne## 8#wellin; in %ront o% the elbow i# the mo#tnotable %eature#,

• Lateral #ide o% elbow i# u#ually tender and e(ion i#

ro##ly re#tri!ted,


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In*e#tiation

• B


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reatment

Undisplaced Fracture• hi# type o% %ra!ture !an be manaed by

#imple #plintae %or wee,

Displaced Fracture• hi# %ra!ture #hould be redu!e and held

• =pen redu!tion and internal f(ation by

f(ed the head radiu# po#ition with a #mall#!rew,


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9ra!ture# o% =le!ranon

-omminuted *# tran#*er#e

"i#pla!ed *# undi#pla!eed


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Me!hani#m o% injury

• "ire!t7 9all on the point o% elbow or dire!t trauma toole!ranon,

– ypi!ally re#ult# in a comminuted ole!ranon %ra!ture,

• Indire!t7 9all onto the out#tret!hed upper e(tremitya!!ompanied by a #tron' #udden !ontra!tion o%tri!ep#,

– ypi!ally re#ult# in a transverse or oblique %ra!ture,

• A !ombination o% the#e may produ!e di#pla!ed'

!omminuted %ra!ture#' or' in !a#e# o% e(treme*iolen!e' %ra!ture


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-lini!al .re#entation

• .atient# typi!ally pre#ent with the uppere(tremity #upported by the !ontralateralhand with the elbow in relati*e e(ion,

•

Abra#ion# o*er olecranon or hand• .alpable de%e!t at %ra!ture #ite

• Inability to e(tend the elbow a!ti*ely aain#tra*ity indi!ate# di#!ontinuity o% tri!ep#

me!hani#m• A##o!iated ulnar ner*e injury i# po##ible' e#p,

with !omminuted %ra!ture# re#ultin %rom

hih


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B


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4adioraphi! E*aluation

• A. *iew7 – hi# #hould be

e*aluated to e(!lude

a##o!iated %ra!ture# ordi#lo!ation#, – he di#tal humeru# may

ob#!ure o##eou# detail#

o% the ole!ranon%ra!ture,


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Mayo -la##if!ation

• ype I7 nondi#pla!ed or minimallydi#pla!ed7 – )ub!ateorie#7 Noncomminuted 8IA;

Comminuted 8I;,

– reatment7 @onoperati*e,

• ype II7 di#pla!ed pro(imal %ramentwithout elbow in#tability7 – )ub!ateorie#7

• IIA7 non!omminuted' !an be treated by ten#ionband wire f(ation,

• II7 !omminuted : require plate f(ation,

– reatment7 =perati*e,

• ype III7 %eature# in#tability o% theulnohumeral joint, – reatment7 =perati*e,


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-ompli!ation

• Joint #ti$ne##

– -an be a*oided with #e!ured internal f(ationand early mobilization,

• @on


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reatment

• Comminuted, triceps intact 7

– Arm re#ted in a #lin %or 1 wee&

– 9urther (


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reatment

• Undisplaced transverse7

– Immobilized by a !a#t in about 60 deree#

o% e(ion' immobilized %or


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6; Elbow di#lo!ation

General

he mo#t !ommon type o%di#lo!ation in !hildren and the#e!ond mo#t !ommon type in adult#'#e!ond only to #houlder di#lo!ation


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ype# o% elbow di#lo!ation#

• .o#terior di#lo!ation7 !au#ed by a %all on theout#tret!hed hand

• Anterior di#lo!ation7 u#ually a hih enerytrauma 8#ide #wipe in motor *ehi!le dri*er#;

• Lateral di#lo!ation7 a medialy dire!ted %or!e onthe humeru# dri*e# the tro!hlea in the #amedire!tion !au#in the ulnar to be di#pla!edlaterally

• Medial di#lo!ation7 a lateraly dire!ted %or!e willdri*e the tro!hlea in the #ame dire!tion and!au#in the ulnar to be di#pla!ed medialy,


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ype# !ont,,

• "i*erent7 a di#lo!ation whi!hwede# the humeru# between theulnar and radiu#, Either antero<

po#terior or mediolateral,


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ype# !ont


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-lini!al 9eature#7

• Inability to bend the elbow %ollowin a %all onout#tret!hed hand

• .ain in the #houlder and wri#t

• .atient# #upport# hi# %orearm with the elbow in #lihte(ion

• ony landmar may be palpable and abnormally pla!ed

=n phy#i!al e(am7

he mo#t important part o% the e(am i# the neuro*a#!ulare*aluation o% the radial artery' and median' ulnar and

radial ner*e#


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-ompli!ation

• EA4LN

/a#!ular injury 8bra!hial artery;

@er*e injury 8median and ulnar

ner*e;


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-ompli!ation

• LAE

)ti$ne## 8lo## o% 0 K 30 deree# o%e(ten#ion;

2eterotopi! o##if!ation 8myo#iti#o##if!an#;

5nredu!ed di#lo!ation

4e!urrent di#lo!ation 8rare;

=#teoarthriti# 8quite !ommon;


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reatment

• Uncomplicated Dislocation7

– 9ully rela(ed under anae#the#ia

–

.ull# on the %orearm while elbow i# #lihtly e(ed – ith one hand' #ideway# di#pla!ement i#

!orre!ted' then the elbow i# %urther e(ed whilethe ole!ranon pro!e## i# pu#hed %orward

– -he!& rane o% mo*ement' #tability'neuro*a#!ular #tatu#

– 2eld in !ollar and !u$ with elbow e(ed abo*e F0deree# %or 3 wee


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reatment

Dislocation with Associated Fractures7

Medial Epi!ondyle

– 4edu!e the epi!ondylar %rament and

f(ed ba!& in po#ition – Arm and wri#t are #plinted with elbow

at F0 deree# %or 3 wee

2ead o% radiu# – 9ra!ture f(ation or pro#theti!

repla!ement


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reatment

Dislocation with Associated Fractures7

=le!ranon pro!e##

– =pen redu!tion with internal f(ation

)ide


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4e%eren!e

• Apley# )y#temi! o% =rthopedi! and9ra!ture

8Fthe Edition;


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mohd_afiq_izzuddin_b._rossli_1001336000_543._15-16(2)

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