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Elbow Dislocation

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4 views

Elbow Dislocation

Uploaded by

rusibane oscar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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ELBOW

DISLOCATION
PREPARED BY :
JOYEUSE ISUBIZABAYO:223010347
VALENTIN TWAHIRWA: 223001928

SUPERVISOR: Dr MUVUNYI Eric


Orthopedic surgeon
OUTLINES
• Epidemiology
• Etiology
• Anatomy
• Classification
• Clinical presentation
• Management
• complication
EPIDEMIOLOGY
INCIDENCE
• Elbow dislocation are most major dislocation second to shoulder
dislocation
• Most common dislocated joint in children
• Account for 10-25 % injury of elbow
• Posterolateral is most common type of dislocation(80%)
• DEMOGRAPHIC
• predominantly affects patients between age 10-20 years old
ETIOLOGY
• Posterolateral mechanism of dislocation :
• It is due to combination of : axial loading ,supination/external rotation of
fore arm ,valgus posterolateral forces.
• varus posterolateral mechanism : external rotation of forearm, axial load
person falls onto an outstretched hand
• greater laxity or looseness in ligaments
• ulna bone that has a shallow groove for the elbow hinge joint
• complete or near complete circular disruption of capsuloligamentous
stabilizers
ETIOLOGY
• progression of injury is from lateral to medial
• LCL fails first (primary lesion)
• by avulsion of the lateral epicondylar origin
• midsubstance LCL tears are less common but do occur
• MCL fails last depending on degree of energy
ANATOMY
• static and dynamic stabilizers of elbow
• static stabilizers (primary)
• ulnohumeral joint: hinge joint
• anterior bundle of the MCL
• LCL complex
• static stabilizers (secondary)
• Radiocapitellar: joint pivot joint
• joint capsule
• origin common flexor and extensor tendons
ANATOMY
• dynamic stabilizers /muscles that cross joint
• muscles that cross the elbow joint.
• anconeus
• brachialis
• Triceps
• Biceps brachii
ANATOMY
CLASSIFICATION

• Anatomic
• posterolateral
• most common
• Simple vs. complex
• simple
• elbow dislocation with no associated fracture
• complex
• elbow dislocation with associated fracture
Classification/triad injury
• elbow dislocation associated with a LUCL tear, radial head
fracture, and coronoid tip fracture characterized by medial
facet fracture , comminuted
• radial head fractures occur in up to 10% of elbow dislocation .
structure of elbow fail from lateral to medial :
• LCL disrupted first
• Anterior capsule second
• Possible MCL disruption
Clinical presentation
• Symptoms
• pain and swelling
• Physical exam
• ATLS
• the status of the skin - evaluate for open injuries
• palpation
• presence of compartment syndrome , status of wrist and
shoulder , neurovascular status
.
IMAGING
• X-rays
• AP and lateral views
• assess joint congruency, especially after attempted reduction
• oblique views
• assess for associated periarticular fractures
• CT scan
• indications
• suspicion of complex injury pattern
• useful to identify associated periarticular fractures
TREATMENT
• NON-OPERATIVE
• Indication :
• acute simple stable dislocations
• recurrent instability after simple dislocations is rare (<1-2% of
dislocations)
• Technique : closed reduction & immobilization
• Process : elbow flexion while placing direct pressure on olecranon ,
in line traction of the elbow to allow coronal movement , forearm
supination to shift coronoid under trochlea
TREATMENT/IMMOBILIZATION

• place post-reduction posterior mold splint in flexion and


appropriate forearm rotation
• splint in at least 90° of elbow flexion last for 5-10 days
• if LCL is disrupted - elbow will be more stable
in pronation
• if MCL is disrupted - elbow will be more stable
in supination
NON-OPERATIVE TREATMENT
POST-REDUCTION
• Radiograph
• to check the presence of the isosceles triangle between
epicondyles and olecranon
• Mal-union
• Bone geometry
OPERATIVE TREATMENT
• Open reduction internal fixation (ORIF) with ligaments repair
• Indication
• LCL complex fracture
• common extensor tendon origin
• coronoid fracture , coronoid tip when is involved (P.insertion
of brachialis)
• capitellum, fractures
• radial head fractures
OPERATIVE TRATMENT
• Radial head arthroplasty
• Hinged external fixators
COMPLICATIONS
• Contractures
• Stiffiness
• Neurovascular injuries
• Varus postmedial instability due to LCL tear
• Compartment syndrome
REFERENCES
• https://www.orthobullets.com/trauma/1018/elbow-dislocati
on?hideLeftMenu=true
• https://www.drbayoud.com/dislocation-elbow
• https://www.google.com/search?q=LUCL&rlz=1C1JZAP_e
nGB1093DE1093&oq=LUCL&gs_lcrp=EgZjaHJvbWUyBgg
AEEUYOdIBCDM3NzNqMGo3qAIAsAIA&sourceid=
• https://www.bing.com/search?q=closed+reduction+pictur
es+of+elbow+dislocation&qs=n&form=QBRE&sp=
• Elbow Dislocation - TeachMeSurgery.pdf

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