Elbow joint is a complex multiarticular joint. Its stability is provided by multiple factors , however unstable elbow is not uncommon .
"Types of elbow instability, how to suspect , diagnose and how to treat" .
All these will be discussed at the lecture which will be presented by Dr. Ahmed Saleh (assistant Lecturer at Mansoura University Hospitals.
Elbow joint is a complex multiarticular joint. Its stability is provided by multiple factors , however unstable elbow is not uncommon .
"Types of elbow instability, how to suspect , diagnose and how to treat" .
All these will be discussed at the lecture which will be presented by Dr. Ahmed Saleh (assistant Lecturer at Mansoura University Hospitals.
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Forearm bones and the work of right sided mid shaft femur and tibia and distal end of radius of right sided intertrochanteric femur and tibia and distal femur
Normal Labour/ Stages of Labour/ Mechanism of LabourWasim Ak
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Normal labor is also termed spontaneous labor, defined as the natural physiological process through which the fetus, placenta, and membranes are expelled from the uterus through the birth canal at term (37 to 42 weeks
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This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
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http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasnât one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
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Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Operation âBlue Starâ is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
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Letâs explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
2. ⶠSimple elbow dislocation is one in which there are no associated fractures
ⶠThe elbow joint is the second most commonly dislocated joint in the adult
population
ⶠAdolescent males are the highest-risk group
3. GROSS ANATOMY
ⶠArticulations
The elbow joint is made up of three articulations
ⶠRadiohumeral: capitellum of the humerus with the radial head
ⶠUlnohumeral: trochlea of the humerus with the trochlear notch (with
separate olecranon and coronoid process articular facets) of the ulna
ⶠRadioulnar: radial head with the radial notch of the ulna (proximal
radioulnar joint)
4. MOVEMENTS
ⶠThe elbow is a trochoginglymoid (combination hinge and pivot) joint
ⶠthe hinge component (allowing flexion-extension) is formed by the
ulnohumeral articulation
ⶠthe pivot component (allowing pronation-supination) is formed by the
radiohumeral articulation and the proximal radioulnar joint
5. LIGAMENTS
ⶠmedial (ulnar) collateral ligament complex
ⶠlateral (radial) collateral ligament complex
ⶠoblique cord
ⶠinconstant thickening of supinator muscle fascia and functionally insignificant
ⶠruns from tuberosity of the ulna to just distal to radial tuberosity
ⶠquadrate ligament (of Denuce)
ⶠthickening of the inferior aspect of the joint capsule
ⶠruns from just inferior to the radial notch of the ulna to insert to the medial
surface of the radial neck
6. PATHOANATOMY AND APPLIED
ANATOMY
ⶠsoft tissue restraints can be divided into both static and dynamic stabilizers
ⶠstatic stabilizers
joint capsule and the LCLs and MCLs
7. LCL
ⶠPrimary varus and posterolateral rotational stabilizer
ⶠLCL has three components-
The radial collateral ligament
annular ligament
The lateral ulnar collateral ligament
8. ⶠThe radial head is surrounded by the annular ligament which attaches to
the anterior and posterior margins of the radial notch of the proximal ulna
ⶠThe radial collateral ligament arises from the lateral epicondyle and blends
with the annular ligament
ⶠThe lateral ulnar collateral ligament is posterior to the radial collateral
ligament
9. ⶠMCL consists of the anterior and posterior bundles
ⶠThe anterior bundle is the key valgus stabilizer of the elbow, arising from
the anteriorinferior aspect of the medial epicondyle to insert on the
sublime tubercle of the proximal ulna
ⶠThe posterior bundle provides a secondary restraint to valgus load and
also resists ulnar rotation
12. ⶠPatients with simple elbow dislocations routinely have disruption of both
the MCL and LCL and the elbow capsule
ⶠThe muscular origins may be disrupted as well; typically the injury to the
lateral common extensor origin is more extensive than the medial common
flexor origin
ⶠMost activities of daily living exert a varus force on the elbow than a valgus
force, residual instability is usually due to incompetence of the LCL in the
majority of patients
13. ⶠThe radial head causes an impression fracture of the posterior capitellum
which can contribute to recurrent instability
14. Mechanisms of Injury
ⶠFall on an outstretched hand
ⶠThe soft tissue injury is thought to begin on the lateral side of the elbow
with disruption of the lateral collateral ligament (LCL) and then proceeds
through the capsule to the medial side with the medial collateral ligament
(MCL) being injured last
15.
16. Associated Injuries
ⶠSimple elbow dislocations are not associated with fractures
ⶠDisruption of the collateral ligaments, elbow capsule, and forearm flexor
and extensor muscle origins
ⶠInjury to the brachial artery has been described in closed simple
dislocations and nerve palsies are possible
ⶠThe ulnar nerve is the most commonly injured nerve following elbow
dislocation
17. Signs and Symptoms
ⶠObvious deformity and pain about the affected elbow
ⶠElbow flexed to 90 degrees, the medial and lateral epicondyles and the
olecranon process should form an isosceles triangle
ⶠComplete peripheral neurologic examination should be performed
18. Imaging and Other Diagnostic Studies
ⶠAnteroposterior, lateral, and oblique radiographs are used to diagnose
elbow dislocation and help to rule out associated fractures
ⶠAlthough rarely required in practice, a line drawn along the anterior
margin of the humerus (anterior humeral line) and one along the long axis
of the radius should intersect near the centre of the capitellum
19. ⶠComputed tomography (CT) scanning is rarely needed but can be useful if
there is a questionable associated fracture
20. ⶠMRI is not needed unless there is concern for ulnar nerve entrapment in
the joint since the pathology of the soft tissue injury associated with elbow
dislocations has been well established
21. CLASSIFICATION
ⶠBased on the direction of dislocation
ⶠSimple versus complex
displacement of the ulna relative to the humerus
Posterior â Posterolateral â Posteromedial â Lateral â Medial â Anterior
27. INJURY PATTERNS
ⶠPosterior dislocation with a fracture of the radial head
ⶠPosterior dislocation with fractures of the radial head and coronoid
processâthe so-called âterrible triadâ injury
ⶠVarus posteromedial rotational instability pattern injuries associated with
anteromedial facet of the coronoid fractures
ⶠAnterior olecranon fracture-dislocations
ⶠPosterior olecranon fracture-dislocations
28. TYPES OF ELBOW INSTABILITY
Posterolateral rotatory instability (elbow dislocations with or without
associated fractures)
Varus posteromedial rotational instability (anteromedial coronoid facet
fractures)
Olecranon fracture-dislocations
30. NONOPERATIVE TREATMENT
ⶠThe majority of simple elbow dislocations can be treated nonoperatively
with closed manipulative reduction evaluation of stability and an early
rehabilitation program
31. TECHNIQUES-PARVINS METHOD
ⶠThe medial and lateral epicondyles are palpated and their relationship to
the olecranon is determined in order to first correct and medial/lateral
displacement in the coronal plane
ⶠThe elbow is typically flexed to approximately 30 degrees, and traction is
placed through the forearm while stabilizing the humerus
ⶠDirect pressure over the olecranon may help to guide it over the distal
humerus and into joint
ⶠSupination of the forearm may be helpful to gain the reduction
32.
33. ⶠAfter reduction-the elbow is taken through an arc of flexionâ extension in
pronation, neutral, and supination in order to evaluate for residual
instability
ⶠThe elbow redislocates when flexed to less than 30 degrees, operative
treatment should be considered
ⶠMost patients will have varusâvalgus instability
34. ⶠThe elbow is then immobilized in a light plaster splint with the forearm in
st
pronation, neutral, or supination (depending on the position of maximal
ability) and the elbow at 90 degrees of flexion
Radiographs are performed to ensure a congruous reduction has been
achieved and to evaluate for the presence of fractures not visualized on the
prereduction radiographs
35. ⶠImmobilization greater than 3 weeks should be avoided as this has been
demonstrated to cause an increased incidence of stiffness and poorer
functional outcomes
36. OUTCOMES
ⶠSeveral studies have reported good to excellent outcomes in the majority
of patients after simple elbow dislocation
ⶠProlonged immobilization after injury was associated with a worse result
with increasing duration of immobilization leading to increased flexion
contracture and more severe residual pain: In general, prolonged
immobilization is to be avoided in this setting
37. OPERATIVE TREATMENT
ⶠThe main indication for operative management of simple elbow
dislocations is an inability to maintain a concentric elbow joint after closed
reduction or a recurrent dislocation
ⶠirreducible dislocations are also indications for operative treatment but
these are rare injuries
38. SURGICAL PROCEDURE
ⶠPatient is placed supine on the operating table with a radiolucent arm
table on the affected side
ⶠPreoperative examination of the shoulder should be performed to be sure
that there is adequate external rotation of the shoulder in order to
approach the medial side of the elbow
39. ⶠSurgical Approach-posterior midline incision is employed and a full
thickness lateral flap is elevated on the deep fascia
ⶠIf the medial structures require repair, full thickness elevation of the medial
flap is performed
40. Soft Tissue Repair
ⶠVast majority of cases, a medial ligament repair is not required and the
surgery is complete
ⶠThe lcl can be repaired using transosseous bone tunnels or suture anchors
ⶠLocking krackow stitches are placed in the lcl while a second suture is
placed in the extensor fascia
41.
42. ⶠIn the unusual setting that the elbow remains unstable in spite of repair of
the lateral structures, the medial side of the elbow is approached with care
taken to protect the ulnar nerve
ⶠThe flexorâpronator muscles are also repaired if they have been avulsed
ⶠelbow is still unstable, then a static or hinged external fixator should be
placed or, as a last resort, the elbow should be transfixed with a screw or
robust Steinman pin
43. EXTERNAL FIXATION
ⶠA hinged fixator will allow for range of motion exercises to be performed
while the external fixator is in place and should be considered if the
surgeon has access to this and the experience to apply it
ⶠStatic fixators are easier to apply and are more widely available
ⶠThe key to all hinged devices is an understanding of the axis of elbow
rotation
ⶠTwo pins are placed in the humeral shaft laterally and two pins are placed
in the ulnar shaft laterally in a position that allows for forearm rotation
44. ⶠOpen pin placement is recommended to avoid injury to the radial nerve
ⶠA static frame is assembled with the elbow joint reduced
ⶠThe external fixator is left in place for approximately 4 weeks and then a
range of motion protocol is initiated as outlined above for closed
treatment
45.
46. ⶠBridge Plate
Indications are conditions where maintenance of reduction is challenging
such as morbid obesity and patients with neurologic injuries such as spasticity
or flaccid paralysis
triceps-splitting approach
Three to four locking screws are placed in the ulna and the distal humerus
avoiding the articulation and fossae
47. ⶠThe plate is removed at 4 weeks, and a posterior capsulectomy and an
elbow manipulation can be considered at the time of plate removal to
increase the recovery of motion
50. COMPLICATIONS
ⶠLoss of motion (stiffness): Stiffness following complicated or
uncomplicated elbow dislocation is usually the rule. Immobilization of the
elbow should generally not go beyond 2 weeks
51. ⶠCompartment syndrome (Volkmann contracture): This may result from
massive swelling due to soft tissue injury
52. ⶠPersistent instability/redislocation: This is rare after isolated,
traumatic posterior elbow dislocation; the incidence is increased in the
presence of an associated coronoid process and radial head fracture
(terrible triad of the elbow)