management

Acute Elbow Dislocation Management

1.  Reduction under IV / conscious sedation

- assistant applies traction in slight flexion

- second person corrects lateral displacement by manipulating olecranon medially

- flexion to 90^o

2.  Post reduction assess stability

Epidemiology

Young men

Aetiology

FOOSH

- axial load, dorsiflexion and radial deviation

DISI occurs in ulna deviation

Herbert Classification

Type A    Stable acute fracture

A1 Tubercle

Definition

Scaphoid non union advanced collapse

Diagnosis

Xray / CT

- non union of scaphoid

- radio-scaphoid OA

Operative Options

Diagnosis

Xray

- sclerosis

CT

Options

Darrach's

- distal ulna excision

- best for elderly RA patient

Bower's interpositional hemiarthoplasty

Technique

Types

Dorsal

- most common

Volar

Causes

1.  Acute traumatic peripheral tear TFCC with DRUJ dislocation

- usually major trauma

- dorsal or volar

2A.  Distal radial fracture

Definition

Combination of scapular neck fracture and ipsilateral clavicle fracture / CC ligament disruption

Imaging

Deformity

Ulna drift & volar dislocation

Causes of MCPJ Deformity

Ulna Drift / Ulna Dislocation

1.  Physiological

Nalebuff Classification

Type I - Boutonniere 

- commonest

- MP flexion /  IP hyperextension

- usually EPB rupture with EPL subluxation

Type II

- Boutonniere & Swan Neck

- doesn't exist according to Nalebuff

Conditions

1.  PIPJ Synovitis

- synovectomy via dorsomedial approach

2.  Flexor tenosynovitis

- may cause trigger finger

- trial HCLA

- remove synovits but don't release A1 pulley

- will worsen ulna drift

3.  DIPJ

- rarely affects