Please download to get full document.

View again

of 20
All materials on our website are shared by users. If you have any questions about copyright issues, please report us to resolve them. We are always happy to assist you.
1. EXTERN CONFERENCE Ext.Piraya Kantanawat 19 March 2018 2. ผู้หญิง 67 ปี ตกจากม้านั่ง ศอกผิดรูป…
  • 1. EXTERN CONFERENCE Ext.Piraya Kantanawat 19 March 2018
  • 2. ผู้หญิง 67 ปี ตกจากม้านั่ง ศอกผิดรูป 7ชั่วโมงก่อนมา รพ. Chief complaint
  • 3. ผู้ป่วยหญิง 67 ปี โรคประจำตัว HT controlled ภูมิลำเนำ ครบุรี นครรำชสีมำ Cause of injury : ล้มจำกม้ำนั่ง แขนซ้ำยกระแทกพื้น เกิดเหตุวันที่ 14 มีนำคม 2561 เวลำ 14.00น. ไปรพช.ครบุรี 19.20น มำรพ.มหำรำช 21.19น
  • 4. PRESENT ILLNESS 7 ชั่วโมงก่อนมำรพ. ขณะยืนบนม้ำนั่งสูง 50cm. ลูกมะพร้ำวตกใส่ตัว เสียหลักล้ม จำกม้ำนั่ง แขนซ้ำยกระแทกพื้น หลังจำก นั้นศอกซ้ำยผิดรูป งอศอกไม่ได้ ปวดแขน ซ้ำย ไม่มีชำปลำยมือ ศีรษะไม่กระแทกพื้น
  • 5. Primary survey A-patent can talk ,post neck not tender B-clear equally both lungs, CCT negative C-BP147/68mmHg ,PR 82bpm full D- E4V5M6 pupil 3mmRTLBE E- deformity Lt.elbow, tender and limit ROM Lt.elbow due to pain , intact sensory and ulna/radial/median n. Motor, radial pulse 2+
  • 6. INVESTIGATION Film Lt elbow AP,Lat จำกรพช
  • 7. MANAGEMENT AT ER Close reduction with Posterior Long arm slab in elbow flexion 90° and supination position
  • 9. ELBOW DISLOCATION Incidence: elbow dislocations are the most common major joint dislocation second to the shoulder most common dislocated joint in children account for 10-25% of injuries to the elbow posterolateral is the most common type of dislocation (80%)
  • 10. ELBOW DISLOCATION Mechanism: most common mechanism is fall onto outstretched arm ❖ Posterior: elbow hyperextension, arm abduction, and forearm supination together cause movement of the olecranon posteriorly (ex: falling onto an extended arm) Anterior: direct force to posterior forearm while elbow is in flexion
  • 11. ELBOW DISLOCATION Symptoms • pain and swelling Physical exam • important to assess • the status of the skin - evaluate for open injuries • presence of compartment syndrome • neurovascular status : esp ulna n. • status of wrist and shoulder concomitant injuries occur in 10-15% of elbow dislocations
  • 12. FINDINGS
  • 13. ELBOW DISLOCATION Classification Simple vs complex: ❖ Simple- dislocation ❖ Complex- dislocation with fracture terrible triad injury : elbow dislocation associated with a LUCL tear, radial head fracture, and coronoid tip fracture radial head fractures occur in up to 10% of elbow dislocations Displacement of ulna relative to humerus ❖ Posterior, posterolateral, posteromedial, lateral, medial, anterior
  • 14. ELBOW DISLOCATION Investigation ❖ film elbow AP, lateral ❖ Oblique view to assess periarticular fx
  • 15. TREATMENT closed reduction and splinting at least 90° for 5- 10 days, early therapy ❑ indications ➢ acute simple stable dislocations recurrent instability after simple dislocations is rare (<1-2% of dislocations) Non-operative
  • 16. TREATMENT ❖ Open reduction, capsular release, and dynamic hinged elbow fixator ❑ indications ➢ chronic dislocations ❑ postoperative ➢ hinged external fixator indicated in chronic dislocation to protect the reconstruction and allow early range of motion Operative ❖ORIF (coronoid, radial head, olecranon), LCL repair, +/- MCL repair ❑indications ➢ acute complex elbow dislocations ➢ persistent instability after reduction (elbow requires >50-60° to maintain reduction) ➢ reduction cannot be performed closed (often due to entrapped soft tissue or osteochondral fragments)
  • 17. REDUCTION •Parvin’s method: patient lies prone with entire upper extremity hanging off the bed, downward traction is applied to the wrist for a few minutes—> olecranon slips distally, arm is then lifted gently (Method A) •Meyn & Quigley method: forearm hangs off of bed, gentle downward traction is applied to wrist, olecranon is guided with opposite hand (Method B)
  • 18. REDUCTION assess post reduction stability elbow is often unstable in extension elbow is often unstable to valgus stress : test by stressing elbow with forearm in pronation to lock the lateral side
  • 19. TAKE HOME POINTS • Three complications of elbow dislocations that must be appreciated and require operative management: 1.neurovascular compromise 2.associated fractures fractures • Simple, uncomplicated dislocations can be treated with closed reduction, splinting and orthopedic follow up in 1-2 weeks
  • 20. REFERENCES w-dislocation
  • We Need Your Support
    Thank you for visiting our website and your interest in our free products and services. We are nonprofit website to share and download documents. To the running of this website, we need your help to support us.

    Thanks to everyone for your continued support.

    No, Thanks