Elbow surgeries

Question 1

Malgaigne (supracondylar) fractures

Answer 1

most common in children

occur above olecranon fossa and are characterized by dissociation of humeral diaphysis from the condyle of the dist humerus

classified based on MOI:

1. EXT type-FOOSH
2. FLX type- force directed against the post aspect of flx elbow (If displaced the sharp prox bone fragment often pierces the triceps and skin causing an open fracture)

surgical mgmt depends on severity

Question 2

Granger (epicondylar) fractures

Answer 2

lateral epicondylar fractures are rare (brief splinting followed by early ROM exercise)

medial epicondylar fractures (3rd most common in children)- incarcarated fragments need ORIF.

check for ulnar neuropathy symptoms

Question 3

Transcondylar humerus fracture

Answer 3

usually seen in older adult patients

mgmt- close reduction and splinting, percutaneous splinting, ORIF

excessive callus formation in the coronoid or olecranon fossa may result in dec ROM

Question 4

Types of transcondylar humerus fractures

Answer 4

transcondylar- intracapsular but extraarticular fracture (common in elderly)

epicondylar fractures- extra articular

condylar fractures- both

Question 5

Intercondylar fractures

Answer 5

most common distal humerus fractures in adults

results from forces directed against the post aspect

mgmt- individualized based on pts age, bone quality, and fracture pattern. ORIF with plates and screws is preferred tx.

Question 6

Radial head fractures

Answer 6

type !- undisplaced, <25% of head

type II- undisplaced

type III- entire head comminuted

type IV- ebow dislocation or montegga fracture

Question 7

Elbow dislocations

Answer 7

classified based on the position of the ulna and radius relative to the distal humerus

Posterolateral most common (11-28%)

divergent- rare (displaced opposite of each other)

Question 8

Elbow dislocations w/ associated fractures

Answer 8

medial and lat epicondyle fractures (12-28%)

coronoid process fractures (5-10%)- grades I, II, III as size inc. type III fractures are associated with recurrent dislocation. ORIF is recommended.

radial head fractures- ORIF recommended with assoc radial head dislocations.

Question 9

Elbow dislocations

Answer 9

loss of ROM (avg 10-15 deg loss of ext with simple locations)

loss of strength

chronic instability

post traumatic instab

neurological or vascular injury

compartment syndrome

ectopic calcification of capsule of collat lig

heterotropic ossification of collat lig or brachialis

patients with have recurrent instability problems

Question 10

Triad injuries

Answer 10

radial head fracture, coronoid fracture, and lig instability

flx arc- 112 deg

pronation/supination- 136 deg