Classify This, Homie!
Anatomy
Treatment
Controversies!
Pot Pourri
100
What is the Regan and Morrey classification system for coronoid fractures?
1989 Type I - avulsion tip Type II - ≤50% process Type III - >50% process A: - elbow dislocation B: + elbow dislocation
100
What are the articulations that make up the elbow?
proximal RU, RC, UT
100
What are indications for nonsurgical treatment of coronoid fractures?
Stable elbow + … Isolated tip ≤ 2 mm OR Small fx <15% loss of height
100
How much of the olecranon can be excised before there is instability?
Literature states 50-80%!
100
What is/are the mechanism(s) of injury for olecranon fracture
Direct - comminution Indirect - avulsion 2/2 triceps contraction
200
What is the Bado classification?
Monteggia Fractures, Bado, 1967 I – ant disloca’n RH + ant angula’n II – post dislca’n RH + post angula’n III – lat RH + metaph fx ulna IV – ant RH + fx ulna/rad
200
What are the primary and secondary stabilizers of the elbow joint?
Primary - Coronoid process, collaterals (primarily LUCL) Secondary - Radial head, capsule
200
What are the surgical options for fixing an olecranon fracture?
ORIF with TBW, screw, plates/screws Excision and triceps advancement
200
What is the disadvantage of excision and triceps advancement for an olecranon fracture?
25% loss of strength, although older studies have shown that about half of people still retain normal strength Repair as dorsally as possible Still need coronoid, MCL, IOM, and DRUJ intact for stability
200
What are alternatives to SS wires for TBW? What is an alternative to K-wires for TBW?
braided cable homerun screw
300
What is the O'Driscoll classification for coronoid fractures?
Anatomic location CT Tip, AM facet, base
300
What is the bare area?
Transverse portion of sigmoid notch not covered by cartilage Separates olecranon from coronoid 2 cm from tip of olecranon
300
Describe a fracture in which you can use the tension band technique.
Displaced simple transverse olecranon fracture
300
Describe a fracture in which you can use the tension band technique.
Displaced simple transverse olecranon fracture
300
What are the possible complications associated with TBW?
Penetration of anterior cortex with K-wires -> AIN injury, impaired forearm rotation
400
What is the Mayo classification for olecranon fractures?
elbow stability, fracture displacement, degree of comminution 1 - Undisplaced 2 - Displaced but stable 3 - Unstable A - noncomminuted, B - comminuted
400
What is functional ROM of the elbow?
30 - 130 degrees
400
What is important to recognize with comminuted olecranon fractures?
Depression of intermediate fragments must addressed to restore articular congruity
400
What is more cost-effective in long-run? TBW or plating?
In 2015, 2 cohorts (10 each) were compared. TBW - No difference in removal of implants. Surgical time less (55 v 85 min), $ less ($6598 vs $14,333) including re-operation. If all HW was removed from TBW, then still would have been less!
400
Describe positioning options for olecranon fracture surgery
Supine with elbow across body Lateral with elbow on Mayo or on surefoot Prone (good if also spine injury)
500
What is the Schatzker classification of olecranon fractures?
Not really used. See PPTx. A - transverse B - transverse impacted C - oblique D - comminuted E - oblique distal F - fracture dislocation
500
What type of joint is the elbow joint?
trochoid ginglymoid
500
Describe how to perform TBW
2 K-wires inserted from the proximal olecranon, cross the fracture line and engage the anterior cortex Cut and twisted into two 90° bends 18g wire passed from medial to lateral and deep to triceps 2nd wire passed through 2 mm drill hole 2 cm distal to fracture Wires crossed to form figure-of-8 and then twisted together
500
What biomechanically causes more compression? TBW or plate and screws?
Plate and screws! Static 77N TBW and 819N plate/screws In fact, during dynamic motion, compression was reduced in the TBW group (and the plate and screw group)
500
what is the most common complication of TBW?
hardware irritation
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