Elbow Imaging and Surgeries Flashcards
What is the 1st image of choice for an elbow
Radiographs
What are the sample standard elbow imaging views (listed)
AP
Lateral
Oblique
What do you see in an AP View of the elbow
- HR and HU joint spaces
- Superimposition of olecranon behind the trochlea
- carrying angle
What do you see in a Lateral View of the elbow
- olecranon and coranoid process
- Radial heads
- Tear drop shape (superimposed medial and lateral epicondyles)
- Sail sign if occult fx
What is the sail sign
anterior fat pad sign represents an intra-articular fracture
What do you see in an Oblique Internal Rotation View of the elbow
- best view of coranoid process
- olecranon is in fossa
- view the space between the trochlea and notch
What do you see in an Oblique External Rotation View of the elbow
- radial head, neck, and tuberosity
- lateral epicondyle
- HR and HU joint spaces
In which X-ray view is the forearm
a. supinated
b. pronated
a. oblique external rotation
b. oblique internal rotation
What do you see in an AP Forearm radiograph
entire radius, ulna & wrist w/normal bowing and contour of the shafts shown
What do you see in a lateral forearm radiograph
- superimposition of radius and ulna
What is a CT scan beneficial for
- viewing a complex fracture to help with surgical planning
What is an MRI good for
Viewing inflammation –> bright white is not good
Supracondylar fx
- above the condyles
- 2nd most common in children
Transcondylar fx
- across the condyles
- more common in the elderly
Intercondylar fx
- splitting the condyles in a Y or T shape
Condylar fx
- medial or lateral
- uncommon in adults, but can be seen in children
Articular fx
- trochlea or capitulum but rare in all age groups
Epicondylar fx
- uncommon in adults but can be from a direct blow
- typically as an avulsion fx in children
What is Cubical Varus?
- a gunstock deformity best seen with the elbow extended
- correct w/ wedge osteotomy
What are surgical options for a simple radial head fx
- ORIF
- fragment excision
- radial head replacement
What are surgical options for a comminuted Fx
- Radial head resection
- radial head replacement
What is a fx of the proximal third of the olecranon
Type I olecranon fx
What is a fx of the middle third of the olecranon
Type II olecranon fx
What is a fx of the distal third of the olecranon
Type III fx
What is the most common type of olecranon fx
Type II
What is done in a distal biceps tendon repair
Re-attach biceps tendon ASAP after an injury
Protocol Post-Op distal biceps tendon repair
- 2 weeks: immobilized at 90 flexion
- Gradual towards full extension 6-8 weeks
- AROM at 6-8 weeks
- 12 weeks: strengthening
When would you do an ulnar nerve transposition surgery
When the nerve subluxes and is very copmressed
Post-Op Protocol ulnar nerve transposition
- brief immobilization 1-2 weeks
- full ROM 4 weeks
- no heavy lifting/repetitive activities for 6 weeks
Indications for UCL reconstruction sx
- Failure via non-operative treatment
- significant dysfunction and persistent pain
- desire to perform at a higher level
- understanding of rehab program
T or F: There is only one type of UCL reconstruction sx
False, there are multiple methods
Post-Op Protocol for UCL Reconstruction
*VARIES
- extension is more important than flexion
- full flexion at 8 weeks
How do you manage dislocations post relocation
- Brief immobilization w/progressive ROM to tolerance as early as 1-2 days post reduction
- No restrictions on ROM
- Strengthening at 6 weeks
T or F: Total Elbow Arthroplasties are very uncommon
True
What is the goal of a total elbow arthroplasty
Relieve pain and maintain functional ROM
What is the expected outcome of a total elbow arthroplasty
- not full ROM
- no heavy lifting
- no throwing/impact activities
