Transcript As The ELBOW Turns

As the ELBOW Bends
MI Zucker, MD
A dr Z lecture
On Common Injuries of the
Elbow and Forearm
of ADULTS and KIDS
ANATOMY: Adult
• AP View
ANATOMY: Adult
• Lateral View
ANATOMY: Kid
• AP View
ANATOMY: Kid
• Lateral View
ANATOMY: Kid
Special Lines
• Anterior Humerus
Line
• Radius-capitellum
Line
The Famous FAT PADS
• Anterior and Posterior
• Intracapsular and
extrasynovial
Anterior FAT Pad
• It is normal, but only
when it’s normal!
• Sharp, small, hugs
bone
Normal Fat Pad
The Posterior FAT Pad
• It is ALWAYS
abnormal!
Abnormal FAT Pads
• Anterior Fat Pad
• Posterior Fat Pad
The Injuries
RADIUS HEAD Fractures
• Very common
• Can be obvious, but
often very subtle or
occult
• Almost always have
abnormal fat pads
Radius Head Fractures
• Most treated very
conservatively: 3
weeks in a sling,
physical therapy.
Radius Head Fractures
• A few need surgery
• The Rule of 3’s
If more than:
– 1/3 of articular surface
involved
– More than 30 degrees
angulation
– More than 3mm
depression
Olecrannon Process Fractures
• Unstable due to triceps
muscle traction
• ORIF
Coronoid Process Ulna Fractures
• May be isolated
-but-
Dislocation
• May be a subtle clue
to a spontaneously or
patient-reduced
dislocation, with
severe ligament
instability
Adult Supracondylar Fractures
• Not subtle, high
energy, very unstable
• ORIF
The KID Elbow
• CRITOE
• The appearance of the
growth centers
The Big 3 of the KID Elbow
• Supracondylar fracture
• Lateral Condyle
fracture
• Medial Epicondyle
avulsion
(In order of prevalence)
Supracondylar Fractures
• Fraught with
complications:
Vascular
Nerve
Osseous
Lateral Condyle Fractures
AP
Medial Epicondyle Avulsion
Fractures
• Little Leaguer’s or
Pitcher’s Elbow
Acute
-orSubacute (stress)
Medial EPICONDYLE Avulsion
Fracture
• Remember: CRITOE
• Internal (medial)
epicondyle
-appears BEFORE• Trochlea
Fractures of the RADIUS and
ULNA Shafts
• Adults and older
children:
• Unstable. ORIF
• In kids, frequently
closed reduction and
cast is OK
MONTEGGIA Fracture
Proximal ULNAR Shaft
Fracture
-andRADIAL Head
Dislocation
ORIF
GALEAZZI Fracture
Distal RADIAL Shaft
Fracture
-andDistal ULNAR
Dislocation
ORIF
Parry Fracture
• AKA “Nightstick
Fracture”
• Isolated usually
nondisplaced ULNA
shaft fracture
KID Forearm Fractures
•
•
•
•
Elastic bowing
Plastic bowing
Greenstick
Torus or buckle
Elastic and Plastic Bowing
• Microfractures
Incomplete or Greenstick
Fractures
One margin of cortex
remains partially intact
Combined
• Plastic bowing
deformity of one bone
• Greenstick or
complete fracture of
the other bone
Torus or Buckle Fracture
• Obvious
• Subtle
Torus or Buckle Fracture
• The LATERAL view
is very helpful in
subtle cases
• Look for the BUMP
INTENTIONAL INJURY
• CHILD ABUSE
An acute and subacute
fracture of the ulna
and a dislocation of
the radius head
INTENTIONAL INJURY
• “SELFOGENIC”
Paper clips
GOODBYE
• Copyright 2004
MI Zucker, MD