Conference Ext.พิรยา   19 มีค. 61

1. EXTERN CONFERENCE
Ext.Piraya Kantanawat
19 March 2018

2. ผู้หญิง 67 ปี ตกจากม้านั่ง ศอกผิดรูป 7ชั่วโมงก่อนมา
รพ.
Chief complaint

3. ผู้ป่วยหญิง 67 ปี โรคประจำตัว HT controlled
ภูมิลำเนำ ครบุรี นครรำชสีมำ
Cause of injury : ล้มจำกม้ำนั่ง แขนซ้ำยกระแทกพื้น
เกิดเหตุวันที่ 14 มีนำคม 2561 เวลำ 14.00น.
ไปรพช.ครบุรี 19.20น
มำรพ.มหำรำช 21.19น

4. PRESENT ILLNESS
7 ชั่วโมงก่อนมำรพ. ขณะยืนบนม้ำนั่งสูง
50cm. ลูกมะพร้ำวตกใส่ตัว เสียหลักล้ม
จำกม้ำนั่ง แขนซ้ำยกระแทกพื้น หลังจำก
นั้นศอกซ้ำยผิดรูป งอศอกไม่ได้ ปวดแขน
ซ้ำย ไม่มีชำปลำยมือ ศีรษะไม่กระแทกพื้น

5. Primary survey
A-patent can talk ,post neck not tender
B-clear equally both lungs, CCT negative
C-BP147/68mmHg ,PR 82bpm full
D- E4V5M6 pupil 3mmRTLBE
E- deformity Lt.elbow, tender and limit ROM Lt.elbow due to pain ,
intact sensory and ulna/radial/median n. Motor, radial pulse 2+

6. INVESTIGATION
Film Lt elbow
AP,Lat จำกรพช

7. MANAGEMENT AT ER
Close reduction with Posterior Long arm slab in
elbow flexion 90° and supination position

8. ELBOW
DISLOCATION

9. ELBOW DISLOCATION
Incidence: elbow dislocations are the
most common major joint dislocation
second to the shoulder
most common dislocated joint in
children
account for 10-25% of injuries to the
elbow
posterolateral is the most common
type of dislocation (80%)

10. ELBOW
DISLOCATION
Mechanism: most common mechanism is
fall onto outstretched arm
❖ Posterior: elbow hyperextension, arm
abduction, and forearm supination
together cause movement of the
olecranon posteriorly (ex: falling onto
an extended arm)
Anterior: direct force to posterior
forearm while elbow is in flexion

11. ELBOW DISLOCATION
Symptoms
• pain and swelling
Physical exam
• important to assess
• the status of the skin - evaluate for open
injuries
• presence of compartment syndrome
• neurovascular status : esp ulna n.
• status of wrist and shoulder
concomitant injuries occur in 10-15% of
elbow dislocations

12. FINDINGS

13. ELBOW DISLOCATION
Classification
Simple vs complex:
❖ Simple- dislocation
❖ Complex- dislocation with fracture
terrible triad injury : elbow dislocation associated with a
LUCL tear, radial head fracture, and coronoid tip fracture
radial head fractures occur in up to 10% of elbow dislocations
Displacement of ulna relative to humerus
❖ Posterior, posterolateral, posteromedial, lateral, medial,
anterior

14. ELBOW DISLOCATION
Investigation
❖ film elbow AP, lateral
❖ Oblique view to
assess periarticular fx

15. TREATMENT
closed reduction and splinting at least 90° for 5-
10 days, early therapy
❑ indications
➢ acute simple stable dislocations
recurrent instability after simple dislocations is
rare (<1-2% of dislocations)
Non-operative

16. TREATMENT
❖ Open reduction, capsular
release, and dynamic hinged
elbow fixator
❑ indications
➢ chronic dislocations
❑ postoperative
➢ hinged external fixator indicated
in chronic dislocation to protect
the reconstruction and allow
early range of motion
Operative
❖ORIF (coronoid, radial head,
olecranon), LCL repair, +/- MCL repair
❑indications
➢ acute complex elbow dislocations
➢ persistent instability after reduction
(elbow requires >50-60° to maintain
reduction)
➢ reduction cannot be performed
closed (often due to entrapped soft
tissue or osteochondral fragments)

17. REDUCTION
•Parvin’s method: patient lies prone with entire upper extremity
hanging off the bed, downward traction is applied to the wrist
for a few minutes—> olecranon slips distally, arm is then lifted
gently (Method A)
•Meyn & Quigley method: forearm hangs off of bed, gentle
downward traction is applied to wrist, olecranon is guided with
opposite hand (Method B)

18. REDUCTION
assess post reduction stability
elbow is often unstable in extension
elbow is often unstable to valgus stress : test by stressing
elbow with forearm in pronation to lock the lateral side

19. TAKE HOME POINTS
• Three complications of elbow dislocations that must be
appreciated and require operative management:
1.neurovascular compromise
2.associated fractures
3.open fractures
• Simple, uncomplicated dislocations can be treated with
closed reduction, splinting and orthopedic follow up in 1-2
weeks

20. REFERENCES
https://www.orthobullets.com/trauma/1018/elbo
w-dislocation
https://coreem.net/core/elbow-dislocation