Authors solution Group 4 Elbow traumafracture dislocation AOTrauma
Author’s solution Group 4: Elbow trauma—fracture dislocation AOTrauma Masters course Harry Hoyen Upper extremity
Case description • • 2 48 -year-old man fell from the roof Right elbow injury Pain, deformity No other injury Neurovascular structures intact Closed injury Moderate swelling
Next step? 3
4 • • • Urgent reduction Plaster fixation Day 9, transfer to hospital • • Other examination? Indication for surgery?
CT scans Coronoid process Radial head 5
Group task • Classify the injury, analyze patterns of injury • Propose the treatment – Repair collateral ligaments? Why? Technique? – Coronoid? – Radial head? – Steps sequence? – Approach(es)? • Prepare presentation, choose creator of presentation, presenter
Author’s solution
Type of injury? Classification? • Mason–Hotchkiss classification of radial head fractures • Coronoid classification of coronoid fractures
Treatment • Posterior approach • Radial head unreconstructable (more than 4 fragments) • Suture anchor in coronoid base • Uncemented radial head replacement • Suture anchor in lateral epicondyle to reattach LCL • Suture anchor in medial epicondyle to reattach MCL due to persistent instability
Postoperative care • Plaster fixation in 90°for 10 days • Supervised physiotherapy • Hinged elbow brace 30– 110 °for 4 weeks • 6 months after ROM 0 -25 -110, P 80, S 80, some residual instability • Stem integration?
Postoperative, 8 months • Pain, some instability, wrist pain • Stem loosening • Infection? Aseptic? • CRP 2. 4 • Reoperation • Removing? • Replacement? • Approach?
Summary—terrible triad • Advantage of posterior approach, access to all involved structures • Radial head replacement is a suitable alternative if reconstruction is not possible • Stable elbow enables early physiotherapy • Use the time-tested implants
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