![Fractures of distal humerus
Mechanism of injury: -high energy except in
osteoporotic.
-falling on flexed elbow > 90 degree.
classification [ A O ] : divided into:
- type A: extraarticular
- typeB: intraarticular unicondylar frct .[one
condyle sheared off and the still in contact with the
shaft.
- typeC: intraarticular bicondylar [no one in
contact with the shaft] . has subgroups:- simpleTorY
- extraarticular
comminution
- intraarticular
comminution](https://image.slidesharecdn.com/asma-150405114107-conversion-gate01/75/Fracture-dislocation-around-the-elbow-16-2048.jpg)
Uploaded byHumanitarian Healthcare field
Fracture & dislocation around the elbow
The document discusses the anatomy, types of fractures, and dislocations of the elbow, including their mechanisms of injury and management strategies. It details the classification of fractures, particularly supracondylar fractures in children, along with the necessary diagnostic and treatment approaches. Additionally, it highlights complications associated with elbow injuries, such as nerve damage and joint stiffness.
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Fracture & dislocation around the elbow
- 1.
- 2. Anatomy of theElbow Bone of elbow 1-humerus 2-radus 3- ulna
- 3. Bony part It issynovial hinge joint between A- the trochlea and the capitulum of the humerous AND B- the trochlear notch of the ulna and the upper surface of the head of radius
- 4. Elbow joint (ligament) 1-radial collateral lig. 2- anular lig. Of radius 3- ulnar collateral lig. 4- transverse lig.
- 5.
- 6. ulnar ligament calledalso the medial collateral ligament. It prevent abduction تباعدof elbow joint. It cosists of 3 bands: Anterior, posterior, Transverse. radial ligament called also The lateral collateral ligament.it prevent adduction of elbow
- 7.
- 9.
- 10. movement in theregion of the elbow Two sits of movements occur in the region of elbow A/flexion and extension . at the elbow joint B/pronation and supination . At Superior radio-ulnar joint Flexors muscle 1/brachialis 2/biceps 3/brachio-radialis 4/flexore of forearm Extensors muscle 1/triceps 2/anconeus Pronator 1/pronator teres 2/pronator quadratus Supinators 1/biceps 2/supinator.
- 11.
- 12.
- 13. Clinical manifistation inMedian nerve injury
- 14. Wrist drop incase of radial nerve injury
- 15. fructures OF THEELBOW fractures of distal end of the humerus fracture of proximal end of radius fracture of the proximal of the ulna Avulsion fracture ◦ Avulsion of the epiphysis of the medial epicondyle ◦ Avulsion fracture of the epiphysis of the lateral epicondyle
- 16. Fractures of distalhumerus Mechanism of injury: -high energy except in osteoporotic. -falling on flexed elbow > 90 degree. classification [ A O ] : divided into: - type A: extraarticular - typeB: intraarticular unicondylar frct .[one condyle sheared off and the still in contact with the shaft. - typeC: intraarticular bicondylar [no one in contact with the shaft] . has subgroups:- simpleTorY - extraarticular comminution - intraarticular comminution
- 18. Fracture of thedistal end of the humerus Classification : 1- Supracondylar. 2- Condylar. 3- Intercondylar.
- 20. 1- Supracondylar fractures Thecommonest fracture in children boy are injured more than girls and more of patient are under 10 years
- 21. Supracondylar fracture Tow typeof supra condylar fracture according to the direction of distalthe fragment (direction of displacement) A/supracodylar fracture with posterior displacement of distal fragment *extension type* account 95% of case cause by fall on the hand with elbow bent
- 22. Supracondyle fracture with posteriordisplacement
- 23. b/supracondylar fracture withanterior displacement of distal fragment flexion type it account 5% of cases it cause by a fall on hand with elbow extended
- 24. Classification according to severityof degree of wilkint Type 1- undisplaced fracture Type 2- Green stick fracture with angulation A- less sever and angulated B- more sever and both angulated and Malrotated. Type 3- completely displaced fracture
- 25. DIAGNOSIS Following the fallchild complain of pain in the elbow and tenderness in the distal humerus and swelling and deformity but the olecranion and medial , lateral epicondyles preserve their normal equilateral triangular relationship X- ray :AP &Lat
- 26. It is essentialto examine fore neurovascular damage .the brachial artery may be affected so pulse examination is essential also nerve injury commonly median nerve
- 27. management 1*supracodylar fracture withposterior displacement –our aim is to secure reduction with no angulation or rotation . the conservative method is the method of choice A*reduction 1/the surgeon exert traction on the injured limb with elbow slightly flexed then flexed the elbow to 80with while pushing forward the lower fragment with his thump.*the radial pulse must be checked if the pulse weak or disappear the degree of elbow flexion is reduced until the pulse returns . B*immobilization by simple collar and cuffis applied . C*rehabilitation immobilization should be continue for 3week after that the child allowed to take the hand out of the cuff for activities such as washing ,dressing and writing. Elbow flexion is encouraged but not extension .operative method indicated if there is vascular damage , the fracture may fixed using kireschner wire ..
- 29. 2*supracondylar fracturewith anterior displacement . this usually reduced by pulling the arm with the elbow fully extended . immobilization is achieved by a plaster slab with the elbow extended for3weeks following by active gradually elbow flexion
- 30. Internal fixation ofsupracondylar fracture
- 31. Complication of supracondylar fractures 1 - early complications a/vascular injury : which if untreated will lead to volkmanns ischaemia b/nerve injury : the median , ulnar and radial nerve are some time injured but usually recover spontaneously .the most common affected is the median nerve.. 2 - late complications a/myositis ossificans . b/stiffness of joint c/malunion . d/late ulnar palsy.
- 37. Dislocation of theelbow Dislocation of ulnohumeral joint in adult more than in children , radioulnar complex is displaced posteriorly or posterolateral often together with fractures. Mechanism of injury 1 Posterior dislocation *the common type 1-because fall on the out striated hand with the elbow extend .2-disruptur of capsuloligamentous structure alone it also lead to posteriolateraly dislocation.*dislocation without recurrent dislocation . not the combination of fractures.
- 38. Posterior dislocation Lateraldislocation
- 39. If there istissue damage may combined with surrounding nerve and vesicular damage sid-swip injury / in car drivers elbow the result forward dislocation with fracture of bone around elbow , soft tissue damage usually sever Clinical features slight flex hand , swelling , deformity , bony land mark in abnormal place , pain ,the hand should be examine for neurovesicular damage
- 40. Treatment Anatomical reduction isessential should be soon as possible . the majority of cases are treated conservatively . surgical intervention may be indicated fore the associated fractures . a-reduction by traction on the forearm in the position in which it lies ,in order to over com biceps and triceps shorting , at the same time the olecranon is pushed forward by thump whilst the elbow is slowly flexed . the stability is then checked by gently moving the elbow through its normal range .b-immobilization . this can be achieved by collar and cuff with or without a posterior slab for 3 week with elbow at 90 flexed .c-rehabilitation Shoulder and finger exercise should command at once .while genteel active . elbow exercise should common after on week.
- 41.
- 42. Complications vascular injuryof brachial artery may occur but with a lesser frequency than in cases of supracondylar fracture . nerve injury . the medial ulnar nerve may be affected .c/myositis ossification ,which is more common if passive exercise is inflicted on the patient. Recurrent of the dislocation may occur if the bony , ligamentous, and muscular support structure are disrupted sufficeintly. late complications 1/stiffness 2/heterotopic ossification 3/unreduced dislocation 4/recurrent dislocation 5/osteoarthritis after sever fracture dislocation.
- 43. Pulled elbow- subluxation ofhead of radius this conation occur in infancy and early childhood. Mechanism of injury is a traction force applied to the elbow in pronatione leading to subluxation of the head which becomes impacted in the orbicular ligament . this condition responds dramatically to quick movement of the forearm in to full supination .
- 44.
- 45. Mechanism of pulledelbow not the radial dislocation
- 46. Full supination for mangmenteof pulled elbow