ELBOW TRAUMA

RADIAL HEAD FRACTURES

MASON CLASSIFICATION

NON-OP TREATMENT

Indications:– Mason 1– Mason 2

Tx: Sling for comfortImmobilization no more than 2 weeks to

prevent elbow stiffness!Fracture displacement and nonunion is usually

asymtomatic and inconsequential (Ring - CORR 2002, Cobb – Orthopedics 1998)

OPERATIVE INDICATIONS

Traditionally 1) >2 mm displacement

2) >30% of joint involvement

Most Importantly: Blocked forearm rotation Mason 3 fracture (displaced comminuted)

OPERATIVE TX OPTIONS

ExcisionORIFArthroplasty

RADIAL HEAD EXCISION

Isolated radial head fracture – No Essex-Lopresti lesion– No terrible triad– No MCL injury

In older patients with limited functional demands

ORIF

Mason type 2: 15/15 had satisfactory resultMason type 3 with 2-3 fragments: 1/12

nonunionMason type 3 with >3 fragments: 13/14 had

unsatisfactory results(Ring JBJS Am 2002)

If >3 fragments, consider arthroplasty

ARTHROPLASTY

N=1680% good or excellent results at 2.8y f/uEarly mobilization important for

satisfactory outcome(Bain JBJS Am 2005)

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)

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)

PROXIMAL ULNA FRACTURES

PROXIMAL ULNA FRACTURES: Treatment Options

Plating Tension Band

TENSION BAND (Macko JBJS Am 1985)

Most common complication: Prominent hardware

Indication: Transverse fracture with no comminution

PLATING (Bailey JOT 2001)

22/25 good or excellent results20% requested plate removal

CORONOID FRACTURES

CORONOID FRACTURE: Morrey and Regan ClassificationType 1: Avulsion of the tip of the processType 2: 50% of the processType 3: >50% of the process

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!

CORONOID FRACTURE: O’Driscoll’s Classification

ELBOW DISLOCATIONS

ELBOW STABILIZERS

1) Lateral collateral ligament

2) Coronoid

3) Radial head

ELBOW DISLOCATION

Non-op or Radial head excision + CastGood results if no coronoid fractureRadial head was ultimate determinant of

outcome with many radial head resections needed to restore forearm rotation(Broberg & Morrey CORR 1987)

TERRIBLE TRIAD

1) Elbow dislocation

2) Coronoid fracture

3) Radial head fracture

CURRENT MANAGEMENT

Radial head ORIF or arthroplastyCoronoid fixation

If still unstable (dislocation with 30° Ext)

LCL + MCL REPAIR

CROSS PINS

EX-FIX

HINDGED BRACE