WARRAICH ROLL17 C Elbow Dislocation Basics History of

WARRAICH ROLL#17 -C Elbow Dislocation Basics History of trauma. Posterior dislocation is most common. Age group : <20 years of age. Rarely, elbow dislocation can occur in elderly patients after a fall. • Common site : ulnohumeral joint. • •

Classification (stimson) Proximal radioulnar joint intact: Posterior (90%): • Posterolateral • Posteromedial • Anterior • Medial • lateral Proximal radioulnar joint disrupted : Anteroposterior • Radius is anterior • Ulna is posterior Medial lateral: • Radius is lateral • ulna is medial

Treeible traid of the elbow : • Posterior dislocation of elbow • Radial head fracture • Fracture of coronoid process of ulna

Pathophysiology • The collateral ligaments usually are ruptured, with injury to the brachialis muscle and coronoid.

Associated Conditions • • • Fracture of the radius Fracture of the ulna Fracture of the humerus Ulnar and median nerve injury Brachial artery injury

Cont. . fig : complex dislocation of the elbow. In addition to dislocation , there are multiple fracture of the elbow.

Cont… • Nerve injury

Cont. . • Artery injuries :

Diagnosis Signs and Symptoms • The patient presents with : • pain, • swelling, • elbow deformity, and • inability to move the elbow.

Physical Exam • Assess the patient's neurovascular status. – Examine the functions of the radial, median, and ulnar nerves before reduction. • The median nerve can be injured at the time of reduction by becoming entrapped in the joint. • check nerve function before and after reduction. – Evaluate the patient for brachial artery injury before reduction. • The brachial artery may be trapped in the joint along with the median nerve. • Vascular injury is an indication for immediate surgery.

Cont. . • Fig :

Cont. . • Artery injuries :

Exam. . • The upper extremity should be inspected for other injuries, such as Monteggia fracturedislocation[fracture of the ulna with radial head dislocation]. • Palpate the forearm for increased swelling or signs of compartment syndrome

Tests Imaging • Radiography: – AP : greater superimposition of distal humerus with proximal ulna and olecranon is seen. – lateral views : coronoid process lies posterior to the condyles of the humerus • CT (fracture pattern). • MRI (ligamentous injury).

Treatment General Measures • arm should be immobilized and elevated, • Cryotherapy • neurovascular status must be evaluated before and after reduction. • rules out associated fractures. • closed reduction under general anaesthesia.

• • • Figure 42. Performance of lateral pivot shift test, . - holds the wrist and the elbow. - The forearm is supinated, and a valgus stress is applied - The “snap” noted by the patients can only be reproduced under general anaesthesia; it occurs around 40° of elbow flexion.

Con. . • fig Figure 42 Performance of lateral pivot shift test, . - holds the wrist and the elbow. - The forearm is supinated, and a valgus stress is applied. - The “snap” noted by the patients can only be reproduced under general anaesthesia; it occurs around 40° of elbow flexion.

Cont. . • fig Figure 43 Performance of lateral pivot shift test on a recumbent patient. The arm is placed alongside the body, in full internal rotation. The forearm is supinated, and axial compression and valgus stress are applied as the elbow is moved from the fully extended to a flexed position.

Surgery • Surgery is indicated for: – Irreducible dislocation – Open dislocation – Neurovascular entrapment – Complex fracture dislocations

• Open reduction and internal fixation are recommended for: – Displaced radial head fractures – Olecranon fractures – Supracondylar humerus fractures • Repair of complex fracture dislocations should be based on restoring stability to the elbow. – by repairing of the coronoid (if possible), restoration of the radial head or radial head replacement, or repair of the collateral ligaments.

Complications • • Neurovascular injury (ulnar – radial – median ) Recurrent dislocation Arthritis Myositis ossificans.

Cont. . • Fig: normal alignment after the elbow has been reduced.

Cont. . • Fig :