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Theatre staff course Mr Lee Van Rensburg March 2012
Elbow fractures Theatre staff course Mr Lee Van Rensburg March 2012
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Anatomy Bones Distal Humerus Proximal radius Proximal ulna Radial head
Anatomy Bones Distal Humerus Proximal radius Radial head Proximal ulna Olecranon
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Anatomy Joints Hinge – Flex and extend Rotation – Supinate and pronate
Anatomy Joints Hinge – Flex and extend Ulna and trochlea Rotation – Supinate and pronate
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Anatomy Joints Hinge (Flexion and extension)
Anatomy Joints Hinge (Flexion and extension) Ulna and trochlea Rotation – Pronation and supination Capitellum and radius
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Proximal ulna shape Greyhen; VOL. 89-B, No. 6, JUNE 2007
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Anatomy - Ligaments Medial view Ulnar collateral ligament Lateral view
Radial collateral ligament Annular ligament
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Anatomy Nerves Ulnar nerve Median nerve Radial nerve
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Radiology Radial head points to capitellum Anterior humeral line
Shaft condylar angle ~ 40 degrees
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40 YO Fall Diagnosis? Treatment ?
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23 YO fall Treatment? Diagnosis?
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TBW
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42 YO motorcycle NO TBW, needs more stability No Ex Fix in this case
42 YO motorcycle NO TBW, needs more stability No Ex Fix in this case Early ROM Diagnosis ? Treatment ?
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24 YO car roll over, open Treatment ? 2 weeks
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65 YO bicycle Treatment ? Diagnosis?
65 YO bicycle Avulsed radial collateral ligament and common extensor origin Treatment ? Diagnosis?
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65 YO bicycle
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45 YO Fall steps Removable slab 6 weeks Free ROM
45 YO Fall steps Removable slab 6 weeks Free ROM Radiograph at 6 months
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40 YO Fall Post Reduction EUA Stable full extension What do you see?
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80 YO Fall Don’t be tempted Treatment ?
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74 YO Fall
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70 YO Fall Classify ? Treatment ? 9 Proximal At most 2 distal screws
70 YO Fall Classify ? Descriptive Treatment ? What is the problem ? 9 Proximal At most 2 distal screws
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20 YO Classify ? Descriptve Treatment ?
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Distal humerus 2 Philosophies
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32 YO 4 months No infection 3 months
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External fixators around the elbow
External fixators around the elbow
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Minor complications (15%)
Minor complications (15%) Erythema and nonpurulent drainage >5 days, 9% Skin release 6% (reduce tension) Major complications (10%) Purulent pin site drainage in 1% Fixator malalignment 1% Pin loosening in 4% Deep infection 4%. No nerve injuries JSES; May 2008 (Vol. 17, Issue 3, Pages )
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45 YO RTA
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Questions
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32 YO Fall Classify ? Early ROM Radiograph at 3 Months Treatment ?
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Full pronation and supination
32 YO fall Classify ? 6 weeks Full pronation and supination 10⁰ FFD Treatment ? Approach ?
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