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As the ELBOW Bends MI Zucker, MD
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A dr Z lecture
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On Common Injuries of the Elbow and Forearm
of ADULTS and KIDS
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ANATOMY: Adult AP View
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ANATOMY: Adult Lateral View
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ANATOMY: Kid AP View
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ANATOMY: Kid Lateral View
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ANATOMY: Kid Special Lines
Anterior Humerus Line Radius-capitellum Line
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The Famous FAT PADS Anterior and Posterior
Intracapsular and extrasynovial
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Anterior FAT Pad It is normal, but only when it’s normal!
Sharp, small, hugs bone
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Normal Fat Pad
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The Posterior FAT Pad It is ALWAYS abnormal!
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Abnormal FAT Pads Anterior Fat Pad Posterior Fat Pad
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The Injuries
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RADIUS HEAD Fractures Very common
Can be obvious, but often very subtle or occult Almost always have abnormal fat pads
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Radius Head Fractures Most treated very conservatively: 3 weeks in a sling, physical therapy.
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Radius Head Fractures A few need surgery The Rule of 3’s If more than:
1/3 of articular surface involved More than 30 degrees angulation More than 3mm depression
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Olecrannon Process Fractures
Unstable due to triceps muscle traction ORIF
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Coronoid Process Ulna Fractures
May be isolated -but-
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Dislocation May be a subtle clue to a spontaneously or patient-reduced dislocation, with severe ligament instability
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Adult Supracondylar Fractures
Not subtle, high energy, very unstable ORIF
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The KID Elbow CRITOE The appearance of the growth centers
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The Big 3 of the KID Elbow Supracondylar fracture
Lateral Condyle fracture Medial Epicondyle avulsion (In order of prevalence)
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Supracondylar Fractures
Fraught with complications: Vascular Nerve Osseous
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Lateral Condyle Fractures
AP
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Medial Epicondyle Avulsion Fractures
Little Leaguer’s or Pitcher’s Elbow Acute -or- Subacute (stress)
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Medial EPICONDYLE Avulsion Fracture
Remember: CRITOE Internal (medial) epicondyle -appears BEFORE- Trochlea
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Fractures of the RADIUS and ULNA Shafts
Adults and older children: Unstable. ORIF In kids, frequently closed reduction and cast is OK
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MONTEGGIA Fracture Proximal ULNAR Shaft Fracture -and-
RADIAL Head Dislocation ORIF
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GALEAZZI Fracture Distal RADIAL Shaft Fracture -and-
Distal ULNAR Dislocation ORIF
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Parry Fracture AKA “Nightstick Fracture”
Isolated usually nondisplaced ULNA shaft fracture
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KID Forearm Fractures Elastic bowing Plastic bowing Greenstick
Torus or buckle
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Elastic and Plastic Bowing
Microfractures
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Incomplete or Greenstick Fractures
One margin of cortex remains partially intact
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Combined Plastic bowing deformity of one bone
Greenstick or complete fracture of the other bone
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Torus or Buckle Fracture
Obvious Subtle
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Torus or Buckle Fracture
The LATERAL view is very helpful in subtle cases Look for the BUMP
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INTENTIONAL INJURY CHILD ABUSE
An acute and subacute fracture of the ulna and a dislocation of the radius head
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INTENTIONAL INJURY “SELFOGENIC” Paper clips
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GOODBYE Copyright 2004 MI Zucker, MD
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