M4Lecture3UpperExtremity上肢影像学.ppt

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Elbow Fracture/Dislocations Elbow Dislocations Epidemiology Accounts for 11-28% of injuries to the elbow Posterior dislocations most common Highest incidence in the young 10-20 years and usually sports injuries Mechanism of injury Most commonly due to fall on outstretched hand or elbow resulting in force to unlock the olecranon from the trochlea Posterior dislocation following hyperextension, valgus stress, arm abduction, and forearm supination Anterior dislocation ensuing from direct force to the posterior forearm with elbow flexed Elbow Dislocations Clinical Evaluation Patients typically present guarding the injured extremity Usually has gross deformity and swelling Careful NV exam in important and should be done prior to radiographs or manipulation Repeat after reduction Radiographic Evaluation AP and lateral elbow films should be obtained both pre and post reduction Careful examination for associated fractures Elbow Fracture/Dislocations Treatment Posterior Dislocation Closed reduction under sedation Reduction should be performed with the elbow flexed while providing distal traction Post reduction management includes a posterior splint with the elbow at 90 degrees Open reduciton for severe soft tissue injuries or bony entrapment Anterior Dislocation Closed reduction under sedation Distal traction to the flexed forearm followed by dorsally direct pressure on the volar forearm with anterior pressure on the humerus Elbow Dislocations Associated injuries Radial head fx (5-11%) Treatment Type I- Conservative Type II/III- Attempt ORIF vs. radial head replacement No role for solely excision of radial head in 2006. Elbow Dislocations Associated injuries Coronoid process fractures (5-10%) Elbow Dislocations Associated injuries Medial or lateral epicondylar fx (12-34%) Elbow Dislocations Instability Scale Type I Posterolateral rotary instability, lateral ulnar collateral ligament disrupted Type II P