L10 UE Surgery Flashcards
Negative predictive factors for healing
age >65
smoking
diabetes
obesity
hyperlipidemia
steroid use
Proximal fractures
common in older patients
more common in women
two part surgical neck is most common
majority are nonoperative
Proximal Fx Tx
Non-op: sling for 6 weeks, PROM
ORIF: young patients, displaced with small amounts
Reverse: older pts, head split or large fracture
Shaft Fractures
may be associated with radial nerve injury (usually young pts)
treatment depends on if its transverse, spiral, comminuted
Tx for Shaft Fx
Majority are non-op
Op: for short oblique/transverse, distracted during surgery. associated injuries are possible, usually using plate fixation.
Nail is used if there’s a tumor, poor bone health, poly trauma, segmental fx
Distal Biceps Rupture
dominant elbow in men 40-60s
sudden excessive eccentric contraction of biceps
loss of supination MMT
need an MRI to determine if its complete/partial
Non-operative tx for distal biceps rupture
low/mod grade tears
low demand or willing to sacrifice function
will retreat over time without surgery
Surgical tx for distal biceps rupture
high grade, full thickness.
repair within 10-14 days
complications: nerve involvement, ossfications, re-rupture, loss of ROM
Full tear classification
40-50% loss supination
30% flexion
Static stabilizers of elbow
anterior capsule
ulnar collateral ligament
radial collateral ligament
Dynamic stabilizers of elbow
flexor pronator mass–> all muscles
mUCL injuries
increasing incidence in young athletes (overhead)
uncommon in skeletally immature
Little League Elbow
risks are high pitch count, early specialization, high pitch veloctiy, shoulder weakness, reduced shoulder ROM, poor trunk rotation, kinetic chain defects
usually a chronic microtruama
Biomechanics of Throwing Stages
Windup
early cocking
late cocking
acceleration
deceleration
follow-through
Wind-up
early stage, muscles prepare/tense
Early cocking
elbow flexes, forearm pronates while shoulder is abducted and ER
Late cocking
elbow flexion increases 90-120°, max shoulder abduction and ER occurs
high elbow valgus force is generated, with very high compression forces at radiocapitellar jt
Acceleration
elbow rapidly extends, humerus adducts and IR as trunk and upper extremity shift forward
elbow accelerates at up to 600,000 deg/s, all valgus load
varus force is generated, 50% is produced by mUCL
Decerleration
initiated at ball release, shoulder maximally IR, flexor pronator mass contracts to prevent impingement of olecranon
greatest amount of GHJ loading, with high tensile force generated on post shoulder
occurs at 500,000 deg/s over a span of 50ms
Follow-through
arm slows, muscles relax
IN acceleration phase…
high valgus force, rapid elbow extension
tensile force on medial stabilizers
compression on lateral radius
medial shear on posterior shoulder
Valgus Extension Overload Causes
- Repetitive stress on UCL causes microtrauma and valgus instability
- Postmedial elbow becomes critical to stability, causing posteromedial impingement
- Lateral compression, which causes radicapitellar joint damage
Valgus extension overload is the
root cause of most elbow problems
Nonoperative tx of mUCL
reccommended for partial tears, non-athletes, acute injury, chronic tears
6 weeks complete rest, 6 weeks strengthening w/out pain, progression
Operative tx of mUCL
recommended for high level throwers, partial tear failure, acute avulsions off ulna, chronic tear failing with nonoperative (usually requires Tommy John’s)
Operative mUCL rehab
first 6 weeks: ROM
second 6 weeks: strengthening
4 mo: throwing
return to sports: 12-15 months
