Crista Supinatoris Fractures of the Proximal Part of the Ulna

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Presentation transcript:

Crista Supinatoris Fractures of the Proximal Part of the Ulna by William Desloges, George S. Athwal, Ilia Elkinson, Graham J.W. King, and Kenneth J. Faber JBJS Essent Surg Tech Volume 5(1):e4 February 25, 2015 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Illustration depicting an osseous avulsion of the lateral ulnar collateral ligament (LUCL) at its insertion on the crista supinatoris. Illustration depicting an osseous avulsion of the lateral ulnar collateral ligament (LUCL) at its insertion on the crista supinatoris. A = annular ligament, P = posterolateral aspect of the joint capsule, RCL = radial collateral ligament, H = distal part of the humerus, and R = radius. (Reproduced with permission of Kari Visscher, MD)‏ William Desloges et al. JBJS Essent Surg Tech 2015;5:e4 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Three-dimensional CT reconstruction of an elbow with a crista supinatoris fracture. Three-dimensional CT reconstruction of an elbow with a crista supinatoris fracture. The path of the lateral ulnar collateral ligament is highlighted in gray. William Desloges et al. JBJS Essent Surg Tech 2015;5:e4 ©2015 by The Journal of Bone and Joint Surgery, Inc.

On the anteroposterior radiograph, the crista supinatoris fragment is obscured by the proximal part of the radius and is difficult to appreciate. On the anteroposterior radiograph, the crista supinatoris fragment is obscured by the proximal part of the radius and is difficult to appreciate. William Desloges et al. JBJS Essent Surg Tech 2015;5:e4 ©2015 by The Journal of Bone and Joint Surgery, Inc.

The crista supinatoris fragment is clearly seen on the external oblique view. William Desloges et al. JBJS Essent Surg Tech 2015;5:e4 ©2015 by The Journal of Bone and Joint Surgery, Inc.

A three-dimensional CT reconstruction provides optimal visualization of the crista supinatoris fracture. A three-dimensional CT reconstruction provides optimal visualization of the crista supinatoris fracture. William Desloges et al. JBJS Essent Surg Tech 2015;5:e4 ©2015 by The Journal of Bone and Joint Surgery, Inc.

William Desloges et al. JBJS Essent Surg Tech 2015;5:e4 ©2015 by The Journal of Bone and Joint Surgery, Inc.

William Desloges et al. JBJS Essent Surg Tech 2015;5:e4 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Intraoperative image of a Monteggia-variant fracture following open reduction and internal fixation of the ulna. Intraoperative image of a Monteggia-variant fracture following open reduction and internal fixation of the ulna. The white arrow points to a displaced fractured crista supinatoris fragment, as visualized through the Boyd interval. With hypersupination, the radial head (r) is posteriorly dislocated and the ulnohumeral joint (black arrow) is subluxated secondary to posterolateral rotatory instability. The radial head is congruent with the lesser sigmoid notch of the proximal radioulnar joint, but traumatic avulsion of the annular ligament from its dorsal attachment is present. William Desloges et al. JBJS Essent Surg Tech 2015;5:e4 ©2015 by The Journal of Bone and Joint Surgery, Inc.

William Desloges et al. JBJS Essent Surg Tech 2015;5:e4 ©2015 by The Journal of Bone and Joint Surgery, Inc.

William Desloges et al. JBJS Essent Surg Tech 2015;5:e4 ©2015 by The Journal of Bone and Joint Surgery, Inc.

William Desloges et al. JBJS Essent Surg Tech 2015;5:e4 ©2015 by The Journal of Bone and Joint Surgery, Inc.

William Desloges et al. JBJS Essent Surg Tech 2015;5:e4 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Cadaveric dissection through the Kocher interval between the extensor carpi ulnaris (ECU) and anconeus. Cadaveric dissection through the Kocher interval between the extensor carpi ulnaris (ECU) and anconeus. The fascia of the extensor carpi ulnaris has been excised, and its muscle belly has been mobilized anteriorly. The deep fascia (D) of the extensor carpi ulnaris is in close apposition with the lateral ulnar collateral ligament. The tip of the hemostat inserted through the Kaplan interval, between the extensor digitorum communis (EDC) and extensor carpi radialis brevis and along the radiocapitellar joint, is seen hooked around the deep fascia of the extensor carpi ulnaris and the capsular thickening representing the lateral ulnar collateral ligament. Fibers of the supinator muscle are seen overlying the distal portion of the lateral ulnar collateral ligament and its insertion on the crista supinatoris (C). These muscle fibers need to be elevated to adequately visualize a crista supinatoris fracture. A = annular ligament and E = lateral epicondyle. William Desloges et al. JBJS Essent Surg Tech 2015;5:e4 ©2015 by The Journal of Bone and Joint Surgery, Inc.

A displaced unstable crista supinatoris fracture and a displaced partial articular radial head fracture, both treated with open reduction and internal fixation. A displaced unstable crista supinatoris fracture and a displaced partial articular radial head fracture, both treated with open reduction and internal fixation. William Desloges et al. JBJS Essent Surg Tech 2015;5:e4 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Postoperative radiograph illustrating screw fixation of the crista supinatoris fracture and radial head fracture. Postoperative radiograph illustrating screw fixation of the crista supinatoris fracture and radial head fracture. William Desloges et al. JBJS Essent Surg Tech 2015;5:e4 ©2015 by The Journal of Bone and Joint Surgery, Inc.

William Desloges et al. JBJS Essent Surg Tech 2015;5:e4 ©2015 by The Journal of Bone and Joint Surgery, Inc.

William Desloges et al. JBJS Essent Surg Tech 2015;5:e4 ©2015 by The Journal of Bone and Joint Surgery, Inc.