The Elbow Fracture Dislocation of the Elbow

Most fracture/dislocations of the elbow are unstable and need ORIF. Dislocations are commonly posterior and are often associated with fractures of radial head, neck and coronoid and soft tissue injuries. Medial epicondylar avulsion is common in adolescents and is a result of associated valgus stress.

Injury to the brachial artery is rare but may range from intimal tear to transection. Arteriography must be done in the OR before reconstruction with a saphenous vein graft is attempted. Arterial thrombosis can lead to delayed occlusion and usually follows intimal tears. As this evolves gradually, monitoring is a must. Dislocation can injure median, ulnar, and anterior interosseous nerves. The majority of nerve injuries are neuropraxic; exploration is indicated only if the nerve fails to recover by 3 to 4 months.

During ORIF, coronoid fracture fixation is very important for the stability of the elbow. Radial head excision without replacement with prosthetic head is contraindicated in the presence of a coronoid fracture. ORIF of the radial head

Figure 3 A and B. Violent open both bone-fracture of the distal forearm sustained in an MVA. Extensive comminution was present at the distal radius. C and D. The circumferential soft tissue injury was treated with splinting and staged debridements until the zone of the injury was completely demarcated. This ringer injury compromised exposure and mandated early definitive treatment. E and F. Radical escharectomy, split-thickness skin grafting, and definitive fixation were performed as staged procedures. Extensive radial comminution required compensatory ulnar shortening. Radial plating of the distal radius provides rigid stability.

Figure 3 A and B. Violent open both bone-fracture of the distal forearm sustained in an MVA. Extensive comminution was present at the distal radius. C and D. The circumferential soft tissue injury was treated with splinting and staged debridements until the zone of the injury was completely demarcated. This ringer injury compromised exposure and mandated early definitive treatment. E and F. Radical escharectomy, split-thickness skin grafting, and definitive fixation were performed as staged procedures. Extensive radial comminution required compensatory ulnar shortening. Radial plating of the distal radius provides rigid stability.

Figure 3 Continued.

is preferable if the head is salvageable. If not, a metallic head implant is substituted and the lateral collateral ligament complex is repaired.

Stiffness and posttraumatic arthritis are common and frustrating complications of elbow fracture/dislocation. Heterotopic ossification is common and can cause total ankylosis. Its severity is proportional to the severity of injury, latent subluxation, and length of immobilization. Indomethacin and radiation therapy are modalities to prevent or minimize this complication.

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