mcl reconstruction [PDF]

treat the radial head fx like without any dislocation, but never resect it. - at the end you need a stable lateral colum

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Idea Transcript


COMPLEX ELBOW INSTABILITY THE ROLE OF THE RADIAL HEAD Bernhard Jost, MD Department of Orthopedics, University of Zurich, Balgrist, Switzerland [email protected]

ACUTE ELBOW INSTABILITY ELBOW DISLOCATION simple:

- ligaments - no bone

simple dislocation

complex:

- ligaments - fracture of articular surface

fracture dislocation

ELBOW DISLOCATION MECHANISM extension - supination torque

ELBOW STABILIZING FACTORS Olecranon

LUCL MUCL

Radial Head Coronoid

ELBOW STABILIZING FACTORS Olecranon

5

LUCL

2 Radial Head

1 4

Coronoid

3

MUCL

COMPLEX DISLOCATION PRIMACY OF CORONOID Olecranon

5

LUCL

2 Radial Head

1 4

Coronoid

3

MUCL

COMPLEX DISLOCATION LIGAMENTS Olecranon

5

LUCL

2 Radial Head

1 4

Coronoid

3

MUCL

ELBOW LIGAMENTS LCL-complex

lateral ulnar collateral ligament (LUCL)

MCL-complex

medial ulnar collateral ligament (MUCL)

LATERAL STABILIZER LAT. ULNAR COLL. LIGAMENT (LUCL) = posterolateral rotatory instability

anatomy LCL: - 3 parts - LUCL major stabilizer

SIMPLE DISLOCATION LIGAMENT REPAIR

acute ligament repair: results comparable to non-surgical no repair

Josefsson PO, JBJS, 69A: 605, 1987

COMPLEX DISLOCATION LIGAMENT REPAIR often not necessary (MUCL),

... but if you are there then repair (LUCL)

COMPLEX DISLOCATION RADIAL HEAD Olecranon

5

LUCL

2 Radial Head

1 4

Coronoid

3

MUCL

COMPLEX DISLOCATION RADIAL HEAD FRACTURES

R.H. Fx 10% Dislocation

FRACTURE MECHANISM

RADIAL HEAD FRACTURES CLASSIFICATION

Mason ML, Br J Surg 42: 123, 1954 Brodberg MA and Morrey BF, JBJS 68A: 669, 1986

RADIAL HEAD FRACTURES TREATMENT

type I

conservative

type II

ORIF or excision

type III

excision or prosthesis

Rockwood and Green, Fractures in Adults: 940ff, 2001

RADIAL HEAD FRACTURES CLASSIFICATION

RADIAL HEAD SECONDARY STABILIZER medial collateral ligament (MCL)

ELBOW DISLOCATION SOFT TISSUE CONSTRAINTS

from lateral to medial: 1. LUCL 2. ant. + post. capsule 3. MUCL

RADIAL HEAD SECONDARY STABILIZER medial collateral ligament (MCL)

TYPE IV RADIAL HEAD FRACTURES TREATMENT - leave - resection, if

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