Extern conference

Orthopaedics

History
21

30 min PTA

Physical examination
V/S : BP 110/60 mmHg , P 82 /min , RR 14 / min , O2 sat 100 % GA : Alert CVS : normal S1,S2 , no murmur RS : chest compression neg , normal and equal BS Abd : soft , not tender NS : E4V5M6 , pupil 3mm BRTL

Physical examination
Affected part (right elbow) : deformity, mild swelling, limit ROM, tenderness, normal distal NV

Differential Diagnosis ??

Investigation
Film right elbow AP, lateral

Film Rt elbow AP & Lateral

Diagnosis
Posterior dislocation of right elbow

Elbow Anatomy

Joint Hinge type Ball and socket type

Elbow dislocation
Most common:
Post./Post.lat.

Dislocation
Mechanism:
Slightly flex elbow

Pronate forearm
Int rotate humerus

Tear of elbow

ligament
ESP., LCL

Clinical Presentation
Immediate instability

Popping' sensation or noise upon dislocation

Olecranon is prominent Abnormal Heuters line Dimples Swelling and bruising around the elbow

Management
Closed reduction under RA or GA

Closed reduction

Complications
Pinched nerves

Trapped arteries
Avulsion fractures Osteoarthritis

Post-Reduction Management
Check joint stability

Check artery
Radial pulse Capillary refill

Check nerve
Radial n. Wrist flexion, Sense: dorsum of hand Ulnar n. Fingers abduction, Sense: 5th finger Median n. Opponens, Sense: 2nd finger

Management In This Patient

Closed reduction under RA
Hematoma block Sedation: Morphine 3 mg IV

Hematoma Block

Closed Reduction

Post Reduction

Film after reduction

Diagnosis
Re-posterior dislocation of right elbow

Management
Closed reduction under RA

Immobilization with posterior slabs

Closed Reduction

Film after reduction

Follow up
24 48 hours:
NeuroVascular, compartment syndrome

1 week:
7 10 days off splint ROM exercise

3 6 months
Completely recovery

TAKE HOME MESSAGE

Elbow dislocation
Most common: Posterior dislocation

Diagnosis
Hx, PE, Film X-ray Elbow AP, Lat

Management
Closed reduction under RA/GA Post-reduction: ALWAYS Check jt. Stability Immobilization NV X-ray Avulsion fracture
F/U: 24-48 hr NV / 1 week off splint