Upload
monther-alkhawlany
View
131
Download
4
Tags:
Embed Size (px)
Citation preview
Fracture &
dislocation
around the
elbow
Anatomy of the Elbow
Bone of elbow
1-humerus
2-radus
3- ulna
Bony part
It is synovial hinge joint
between
A- the trochlea and the
capitulum of the
humerous AND
B- the trochlear notch of
the ulna and the upper
surface of the head of
radius
Elbow joint (ligament)
1- radial collateral lig.
2- anular lig. Of radius
3- ulnar collateral lig.
4- transverse lig.
.1Vbbnjjmjujmm
ulnar ligament called also the
medial collateral ligament. It
prevent abduction تباعدof elbow
joint. It cosists of 3 bands:
Anterior, posterior, Transverse.
radial ligament called also
The lateral collateral ligament.it
prevent adduction of elbow
Muscles
a
Artery &Nerve
Median n
radial n
ulnar n
movement in the region of
the elbow
Two sits of movements occur in the region of elbow
A/flexion and extension . at the elbow joint
B/pronation and supination . At Superior radio-ulnar joint
Flexors muscle 1/brachialis 2/biceps 3/brachio-radialis 4/flexore of forearm
Extensors muscle 1/triceps 2/anconeus
Pronator 1/pronator teres 2/pronator quadratus
Supinators
1/biceps 2/supinator.
Movement of elbow
fracture Hx & Ex
Clinical manifistation in Median
nerve injury
Wrist drop in case of radial
nerve injury
fructures OF THE ELBOW
fractures of distal end of the humerus
fracture of proximal end of radius
fracture of the proximal of the ulna
Avulsion fracture
◦ Avulsion of the epiphysis of the medial
epicondyle
◦ Avulsion fracture of the epiphysis of the
lateral epicondyle
Fractures of distal humerus Mechanism of injury: -high energy except in
osteoporotic. -falling on flexed elbow > 90 degree.
classification [ A O ] : divided into:
- type A: extraarticular
- typeB: intraarticular unicondylar frct .[one condyle sheared off and the still in contact with the shaft.
- typeC: intraarticular bicondylar [no one in contact with the shaft] . has subgroups:- simpleTorY
- extraarticular comminution
- intraarticular comminution
Fracture of the distal end of
the humerus
Classification :1- Supracondylar.
2- Condylar.
3- Intercondylar.
1- Supracondylar fractures
The commonest fracture in
children
boy are injured more than girls and
more of patient are under 10 years
Supracondylar fracture
Tow type of supra condylar fracture
according to the direction of distalthe
fragment (direction of displacement)
A/supracodylar fracture with posterior
displacement of distal fragment *extension type* account 95% of case
cause by fall on the hand with elbow bent
Supracondyle fracture with
posterior displacement
b/supracondylar fracture with anterior
displacement of distal fragment
flexion type it account 5% of cases it
cause by a fall on hand with elbow
extended
Classification according to
severity of degree of wilkintType 1- undisplaced fracture
Type 2- Green stick fracture with angulation
A- less sever and angulated
B- more sever and both angulated and
Malrotated.
Type 3- completely displaced fracture
DIAGNOSISFollowing the fall child
complain of pain in
the elbow and
tenderness in the
distal humerus and
swelling and deformity
but the olecranion and
medial , lateral
epicondyles preserve
their normal
equilateral triangular
relationship
X- ray :AP &Lat
veiw
It is essential to examine
fore neurovascular
damage .the brachial
artery may be affected so
pulse examination is
essential also nerve
injury commonly median
nerve
management1*supracodylar fracture with posterior
displacement –our aim is to secure reduction with no angulation or rotation . the conservative method is the method of choice
A*reduction 1/the surgeon exert traction on the injured limb with elbow slightly flexed then flexed the elbow to 80with while pushing forward the lower fragment with his thump.*the radial pulse must be checked if the pulse weak or disappear the degree of elbow flexion is reduced until the pulse returns .
B*immobilization by simple collar and cuffis applied . C*rehabilitation immobilization should be continue for 3week after that the child allowed to take the hand out of the cuff for activities such as washing ,dressing and writing. Elbow flexion is encouraged but not extension .operative method indicated if there is vascular damage , the fracture may fixed using kireschner wire ..
2*supracondylar fracture with
anterior displacement . this usually
reduced by pulling the arm with the
elbow fully extended . immobilization
is achieved by a plaster slab with the
elbow extended for3weeks following
by active gradually elbow flexion
Internal fixation of supracondylar
fracture
Complication of supracondylar
fractures 1 - early complications a/vascular injury : which if untreated will
lead to volkmanns ischaemia b/nerve injury : the median , ulnar and
radial nerve are some time injured but usually recover spontaneously .the most common affected is the median nerve..
2 - late complications a/myositis ossificans . b/stiffness of
joint c/malunion . d/late ulnar palsy.
Dislocation of the elbowDislocation of ulnohumeral joint in adult more than in children , radioulnar complex is displaced posteriorly or posterolateral often together with fractures.
Mechanism of injury 1
Posterior dislocation *the common type
1-because fall on the out striated hand with the elbow extend .2-disruptur of capsuloligamentous structure alone it also lead to posteriolateraly dislocation.*dislocation without recurrent dislocation . not the combination of fractures.
Posterior dislocation Lateral dislocation
If there is tissue damage may combined with surrounding nerve and vesicular damage
sid-swip injury / in car drivers elbow the result forward dislocation with fracture of bone around elbow , soft tissue damage usually sever
Clinical features slight flex hand , swelling , deformity , bony land mark in abnormal place , pain ,the hand should be examine for neurovesicular damage
TreatmentAnatomical reduction is essential should be soon as possible . the majority of cases are treated conservatively . surgical intervention may be indicated fore the associated fractures . a-reductionby traction on the forearm in the position in which it lies ,in order to over com biceps and triceps shorting , at the same time the olecranon is pushed forward by thump whilst the elbow is slowly flexed . the stability is then checked by gently moving the elbow through its normal range .b-immobilization . this can be achieved by collar and cuff with or without a posterior slab for 3 week with elbow at 90 flexed .c-rehabilitation Shoulder and finger exercise should command at once .while genteel active . elbow exercise should common after on week.
Anterior dislocation
Complications vascular injury of brachial artery may occur but
with a lesser frequency than in cases of supracondylar fracture .
nerve injury . the medial ulnar nerve may be affected .c/myositis ossification ,which is more common if passive exercise is inflicted on the patient.
Recurrent of the dislocation may occur if the bony , ligamentous, and muscular support structure are disrupted sufficeintly.
late complications 1/stiffness 2/heterotopic ossification 3/unreduced dislocation 4/recurrent dislocation 5/osteoarthritis after sever fracture dislocation.
Pulled elbow- subluxation
of head of radius this conation occur in infancy and early childhood.
Mechanism of injury is a traction force applied to the elbow in pronatione leading to subluxation of the head which becomes impacted in the orbicular ligament .
this condition responds dramatically to quick movement of the forearm in to full supination .
Pulled elbow
Mechanism of pulled elbow
not the radial dislocation
Full supination for
mangmente of pulled elbow