1. ELBOW TRAUMA

2. RADIAL HEAD FRACTURES

3. MASON CLASSIFICATION

4. NON-OP TREATMENT Indications: Tx: Sling for comfort
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)

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

6. OPERATIVE TX OPTIONS
Excision
ORIF
Arthroplasty

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

8. 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

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

16. 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)

17. IMPLANT PLACEMENT ON RADIAL HEAD
110° safe zone on lateral aspect to prevent impingement in sigmoid notch
Make horizontal marks in forearm in neutral, 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)

18. PROXIMAL ULNA FRACTURES

20. PROXIMAL ULNA FRACTURES: Treatment Options
Plating
Tension Band

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

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

30. CORONOID FRACTURES

31. 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

32. 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!

33. CORONOID FRACTURE: O’Driscoll’s Classification

34. ELBOW DISLOCATIONS

35. Lateral collateral ligament Coronoid Radial head
ELBOW STABILIZERS
Lateral collateral ligament
Coronoid
Radial head

36. 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)

37. Elbow dislocation Coronoid fracture Radial head fracture
TERRIBLE TRIAD
Elbow dislocation
Coronoid fracture
Radial head fracture

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

39. LCL + MCL REPAIR

40. CROSS PINS

41. EX-FIX

42. HINDGED BRACE