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Upper Extremities
Instabilität , Trauma Fortbildung Ellenbogen Schulthess
Klinik 25.10.2012
Fabrizio Moro
Upper Extremities
Einführung
• Demographische Daten– Zweithäufigste Luxation nach der Schulter
• 6 per 100,000
– 10-25% aller Ellenbogen Verletzungen
• Komplizierte (Complex) vs unkomplizierte (Simple)
Upper Extremities
Current Concepts Review Fracture-Dislocation of the Elbow*1998 by The Journal of Bone and Joint Surgery,BY DAVID RING, M.D.t, AND JESSE B. JUPITER, M.D.f, BOSTON, MASSACHUSETTS
Upper Extremities
Horii Circle
Stage 1 Disruption of the LUCL
Stage 2 -posterior an anterior soft tissue disruption
- Stage 3- MUCL posterior bundle
-Stage 3 BEntire MCL Complex is compromised
Clin Orthop 1992 ; 280:186-197
Soft tissue disruption which occurs with elbow dislocation
Upper Extremities
In the presence of an intact medial collateral ligament the radial headcontributes 30 % of valgus stability, whereas in medial ligament disruption the radial head becomes the main constraint, contributing 70% of valgus stability
Upper Extremities
Coronoid Frakturen Klassifikation Regan / Morrey
Typ 1 Spitze
Typ 2 < 50 %
Typ 3 > 50 %
Upper Extremities
Klassification: Koronoid Frakturen
• O’Driscoll Classification • Type I: tip• Type II: anteromedial facet • Type III: base
Upper Extremities
Type 1 ‘‘tip’’ coronoid fracture. Type 2 ‘‘mid-transverse’’ coronoid fracture
Type 3 ‘‘basal’’ coronoid fracture Type 4 AM ‘‘oblique’’ anteromedial coronoid fracture
CT basierte Frakturmorphologie
J Shoulder Elbow Surg (2012) 21, 782-788
Upper Extremities
Stabilität Ellenbogen
• MCL und Radiuskopf : Valgus Stabilität
• Radiuskopf Koronoid : Posteriore Stabilität
• Radiales Kollateralband und Coronoid : Varusstabilität
Upper Extremities
Simple elbow dislocation capsular and ligamentous injuries
• Johanson 1962 0/31• Protzmann 1978 0/27• Mehlhoff 1988 0/52
In only rare instance redislocation
Upper Extremities
Komplexe Ellenbogen Dislokation Terrible triade
Radiuskopffraktur
Coronoid Fraktur
LUCL Ruptur
Upper Extremities
Kardinal Fragen
• Radiuskopf : Osteoynthese versus Prothese
• Koronoid Fraktur fix or not fix
• Do I need to go medial
• Bewegunsfixateur