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Elbow injuries - upper limb update from Melbourne Arm Clinic


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Elbow injury update from Melbourne Arm Clinic

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Elbow injuries - upper limb update from Melbourne Arm Clinic

  1. 1. Elbow injuries
  3. 3. Elbow Dislocations • I prefer to see every dislocation. • A lot of the Emergency departments don’t record if the Elbow is stable or not at the time of enlocation and they are sent off as “ simple “ elbow dislocations. • A lot of injuries are missed in the process
  4. 4. • Example:
  5. 5. • EARLY diagnosis and appropriate investigations by means of x rays and Ct , rarely MRI are important for treatment • Treatment involves ligament reconstruction or repair, and fixation of bony fragments with an aim to start early physical therapy, and minimize stiffness
  6. 6. Radial head fractures • Very common • Generally after a fall on an outstretched hand • X rays and sometimes CT are required.
  7. 7. • When to refer? • 1. Displaced fractures • 2. in conjunction with other injuries such as fractures around the elbow or soft tissue injuries • 3. communited fractures • A lot of the population have simple undisplaced fractures that can be treated in a sling for 10 days and mobilize as soon as the swelling and pain settle , which is generally around the 5 days mark. • These have predictable and good results
  8. 8. TERRIBLE TRIAD INJURY • Elbow dislocation • Coronoid Fracture • Radial head fracture
  9. 9. • This needs fixation always and a dedicated physiotherapy protocol that can be found on our Melbourne Arm Clinic website, in order to get the best outcome from a “ terrible” injury.
  10. 10. Olecranon fractures • A very common fracture! • Can range from simple • To complex!
  11. 11. • Do all of them need fixing?
  12. 12. Imaging • X rays • Ct is always helpful to assess joint damage
  13. 13. • Questions to ask on seeing an olecranon fracture: • Is the fracture displaced on x rays? • Is there an element of joint depression on the ct? • Is there any other bony injury , such as radial head fracture in the same limb? • An answer of yes to any of the above , points towards surgery
  14. 14. Distal Humerus fractures • Increasing spectrum of injury • Severe with relatively poorer outcomes • X rays and ct always are required
  15. 15. In the elderly
  16. 16. Goals of management • Fix securely • Move early • Minimize the risk of arthritis in the future. • They do get stiff irrespective of how good the radiological result is • A lot of them get ulnar nerve neuritis partly as a result of the injury and partly due to the surgery • In the elderly, non salavageable distal humerus fractures can be treated with an elbow arthroplasty with good results
  17. 17. Presenting late • What do we do to a patient who had a bad multi ligament injury to the elbow in the setting of an elbow dislocation, but was missed in the ED as he was sent home immediately after the elbow reduction, and now presents to you 3-4 weeks later, stiff yet unstable? • Unfortunately , see it from time to time • A bad result. • Surgical pathway should still be considered • Can reconstruct the ligaments not repair them, using expendable tendons as graft material
  18. 18. • The aim is to move them early again, after stable fixation • Wont be a good result , in terms of range of motion, but will certainly do better with surgery than without!