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ELBOW TRAUMA

RADIAL HEAD FRACTURES

MASON CLASSIFICATION

NON-OP TREATMENT
Indications:
– Mason 1 – Mason 2

Tx: Sling for comfort Immobilization no more than 2 weeks to prevent elbow stiffness! Fracture displacement and nonunion is usually asymtomatic and inconsequential
(Ring - CORR 2002, Cobb – Orthopedics 1998)

OPERATIVE INDICATIONS  Traditionally 1) >2 mm displacement 2) >30% of joint involvement  Most Importantly: Blocked forearm rotation  Mason 3 fracture (displaced comminuted) .

OPERATIVE TX OPTIONS Excision ORIF Arthroplasty .

RADIAL HEAD EXCISION Isolated radial head fracture – No Essex-Lopresti lesion – No terrible triad – No MCL injury In older patients with limited functional demands .

ORIF Mason type 2: 15/15 had satisfactory result Mason type 3 with 2-3 fragments: 1/12 nonunion Mason type 3 with >3 fragments: 13/14 had unsatisfactory results (Ring JBJS Am 2002) If >3 fragments. consider arthroplasty .

ARTHROPLASTY N=16 80% good or excellent results at 2.8y f/u Early mobilization important for satisfactory outcome (Bain JBJS Am 2005) .

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SURGICAL ANATOMY Pronation of forearm translates PIN 1 cm away from operative field Safe zone of lateral radius: Proximal 38 mm Supination decreases safe zone to 22 mm (Diliberti JBJS Am 2000) .

pronation and supination  Limits: – Anterior: ½ distance from between mark in neutral and supination – Posterior: 2/3 distance from between mark in neutral and pronation  (Corresponds to region between Listers tubercle and radial styloid) .IMPLANT PLACEMENT ON RADIAL HEAD  110° safe zone on lateral aspect to prevent impingement in sigmoid notch  Make horizontal marks in forearm in neutral.

PROXIMAL ULNA FRACTURES .

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PROXIMAL ULNA FRACTURES: Treatment Options Plating Tension Band .

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TENSION BAND (Macko JBJS Am 1985) Most common complication: Prominent hardware Indication: Transverse fracture with no comminution .

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PLATING (Bailey JOT 2001) 22/25 good or excellent results 20% requested plate removal .

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CORONOID FRACTURES .

CORONOID FRACTURE: Morrey and Regan Classification Type 1: Avulsion of the tip of the process Type 2: 50% of the process Type 3: >50% of the process .

CORONOID FRACTURES  Type 1: Sutures around the fragment  Type 2: Sutures through drill holes in ulna  Type 3: Screws  Small fragments associated with more challenging injury pattern! .

CORONOID FRACTURE: O’Driscoll’s Classification .

ELBOW DISLOCATIONS .

ELBOW STABILIZERS 1) Lateral collateral ligament 2) Coronoid 3) Radial head .

ELBOW DISLOCATION Non-op or Radial head excision + Cast Good results if no coronoid fracture Radial head was ultimate determinant of outcome with many radial head resections needed to restore forearm rotation (Broberg & Morrey CORR 1987) .

TERRIBLE TRIAD 1) Elbow dislocation 2) Coronoid fracture 3) Radial head fracture .

CURRENT MANAGEMENT Radial head ORIF or arthroplasty Coronoid fixation If still unstable (dislocation with 30° Ext)  .

LCL + MCL REPAIR .

CROSS PINS .

EX-FIX .

HINDGED BRACE .