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under varus stress. In Group B, the ulnar collateral ligament was more commonly injured than the lateral ulnar collateral ligament, and lateral bone contusion accompanied most cases.PL dislocation is thought to start from the medial side in contrary to PM dislocation beginning at the lateral side. If the disengagement of the coronoidprocess is not completed due to the insufficient valgus/varus distraction, a coronoidfracture will develop at the same time as the elbow dislocation during PFER.
or muscle disorders Eagle syndrome (calcified stylohyoid ligament or an elongated styloid process) Trismus Depressed fracture of the zygomatic arch Infection Osteochondroma of the coronoidprocess Pericoronitis Patients are asked to describe the pain and designate painful areas. The muscles of mastication (temporalis, masseters, and medial and lateral pterygoids) and cervical and occipital muscles are palpated for general tenderness and trigger points (spots that radiate pain to another area). Patients
(see ). Intra-articular (true) ankylosis must be distinguished from extra-articular (false) ankylosis, which may be caused by enlargement of the coronoidprocess, depressed fracture of the zygomatic arch, or scarring resulting from surgery, irradiation, or infection. In most cases of true ankylosis, x-rays of the joint show loss of normal bony architecture. Treatment may include a condylectomy if the ankylosis is intra-articular or an ostectomy of part of the ramus if the coronoidprocess
of the injury, proper radiographic studies are imperative. In contrast to some earlier reports that advise a conservative approach, we performed a very aggressive operative treatment. To ensure anatomic reconstruction of the elbow, surgical exposure of the various injuries was performed first. After gross reduction of the joint dislocation, definitive osteosynthesis of the distal radius fracture was performed. Subsequently, the coronoidprocess and lateral collateral ligament could be repaired anatomically (...) Pediatric Complex Divergent Elbow Dislocation. A divergent dislocation of the elbow is a very rare injury, and only a few cases have been described in the literature. It is characterized as a dorsal dislocation of the ulnohumeral joint combined with a lateral dislocation of the proximal radius. All three articulations of the elbow joint are involved. Like in our case, it can be accompanied by an avulsion fracture of the coronoid and a distal radius fracture. For correct understanding
Treatment of Complex Elbow Injuries With a Postoperative Custom-Made Progressive Stretching Static Elbow Splint. Complex elbow injuries consist of fractures of one or several of the bony stabilizers of the elbow, including the radial head, proximal ulna, coronoidprocess, collateral ligaments, and capsular complex. These injuries, if not properly treated, were reported to have a poor prognosis with recurrent instability, stiffness, posttraumatic arthrosis, and pain. This study was conducted (...) to review clinical outcomes after fracture stabilization and ligament repair with a postoperative custom-made progressive stretching (CMPS) elbow splint in the treatment of complex elbow injuries.From December 2001 to October 2006, 14 patients with complex elbow fractures or instability underwent surgery in Far Eastern Memorial Hospital by Chang Chih-Hung, using suture anchors. All patients used our CMPS static elbow splint postoperatively. No hinged elbow external skeletal fixator was necessary
fractured sites are the body of the mandible, condyle, angle, symphysis, ramus and the coronoidprocess. The cause of the injury may be road traffic accidents, assault, falls, industrial injuries or sports injuries but the relative number of each varies considerably between countries and areas. Under the age of 25, dental trauma accounts for more lost teeth than caries or gum disease. [ ] In terms of violence, young males are most at risk with alcohol an aggravating factor. Women and children are much (...) Mandibular Dislocation Mandibular Fractures. Common Mandibular Fractures | Patient TOPICS Try our Symptom Checker TREATMENT RESOURCES Try our Symptom Checker PROFESSIONAL Upgrade to Patient Pro / / Search Mandibular Fractures and Dislocations Authored by , Reviewed by | Last edited 10 Jun 2016 | Certified by This article is for Medical Professionals Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK
fractured sites are the body of the mandible, condyle, angle, symphysis, ramus and the coronoidprocess. The cause of the injury may be road traffic accidents, assault, falls, industrial injuries or sports injuries but the relative number of each varies considerably between countries and areas. Under the age of 25, dental trauma accounts for more lost teeth than caries or gum disease. [ ] In terms of violence, young males are most at risk with alcohol an aggravating factor. Women and children are much (...) Mandibular Fractures Mandibular Fractures. Common Mandibular Fractures | Patient TOPICS Try our Symptom Checker TREATMENT RESOURCES Try our Symptom Checker PROFESSIONAL Upgrade to Patient Pro / / Search Mandibular Fractures and Dislocations Authored by , Reviewed by | Last edited 10 Jun 2016 | Certified by This article is for Medical Professionals Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK
for the masseter muscle and protects the temporalis muscle and the coronoidprocess. Fractures The most common orbital injury is a 'blowout' fracture, usually involving the orbital floor ± the medial wall. The malar complex is also commonly fractured in isolation by a blow to that area. The bones are either fractured or dislocated. The strong central part of the bone usually remains intact and the force is transmitted to the three buttresses, individually or simultaneously (a 'tripod' fracture) resulting (...) views are facial, occipitomental and submento-vertical. Interpretation may be difficult - systematically check for: [ ] The orbital outline - the droplet sign shows soft tissue prolapsing into the maxillary sinus in an orbital floor fracture. The sinus outline - any opacification or fluid level in the maxillary sinus is suggestive of a fracture. An 'elephant's trunk' - follow the zygomatic line laterally and the maxillary line medially. The coronoidprocesses which should be equidistant from
), and . The mechanism of injury There are a variety of possible injuries because of the presence of three bones and the range of mechanisms of injury. Mechanism of injury in elbow fractures and dislocation Radial head and neck fractures Fall on to an outstretched hand Olecranon fractures Elderly - indirect trauma by pull of triceps and brachioradialis Children - direct blow to elbow Fractures of the coronoidprocess Fall on to an extended elbow as for elbow dislocation Fractures of the distal humerus Fall (...) stable, gentle supination and pronation exercises are appropriate, using a sling or removable posterior splint for comfort. Flexion and extension exercises after two weeks. Fractures of the coronoidprocess Mechanism of injury The mechanism of injury is as for elbow dislocation and such fractures are associated with elbow dislocation in about 40% of cases Clinical features Patients present with tenderness over the antecubital fossa and swelling about the elbow. Check strength of the radial pulse
from 1980, both to 30th January 2006. Last search was done in January 2006.Randomised controlled trials involving people over 55 years of age with fractures in the symphysis, parasymphysis, body, angle, ramus, condyle, and coronoidprocess of atrophic edentulous mandibles in which the fracture was a result of trauma, implant insertion or due to pathological fracture. Any studies that compared methods of management (open or closed reduction or fixation) were to be included.Screening of eligible (...) Management of the fractured edentulous atrophic mandible. Fractures of the atrophic and edentulous (toothless) mandible (lower jaw) are fairly common in elderly people. Atrophy and weakening tend to occur as a result of reduced vascularity and decreased blood flow. Treatment options for reduction and fixation include closed and open techniques, with the degree of atrophy having a significant influence on the type of treatment. Many methods have been proposed for treating fractures
ulnar, olecranon and coronoidprocessfractures. Participants included in the review Adult patients with ulnar shaft fractures. Studies of child participants, olecranon fractures, and combined radial and ulnar fractures were excluded. Outcomes assessed in the review The outcome measures were time to union, nonunion rate, functional outcome, residual deformity and complication rates. Five publications which did not define outcome measures sufficiently to allow analysis, or were seriously flawed, were (...) the results, but should be viewed with much caution because of limitations in the quality of the review process. Implications of the review for practice and research The authors did not state any implications for further research and practice. Bibliographic details Mackay D, Wood L, Rangan A. The treatment of isolated ulnar fractures in adults: a systematic review. Injury 2000; 31(8): 565-570 PubMedID Indexing Status Subject indexing assigned by NLM MeSH Adult; Bone Nails; Bone Plates; Casts, Surgical
procedure were excluded. Of the twenty-six patients, twenty-two had an associated elbow dislocation, and thirteen of them also had an associated fracture of the coronoidprocess. Patients were prospectively followed at three, six, twelve, and twenty-four months. Self-reported limb function, general health, range of motion, and isometric strength were assessed by an independent observer.Following treatment of the injury, significant decreases in self-reported and measured impairments were noted over time (...) Comminuted radial head fractures treated with a modular metallic radial head arthroplasty. Study of outcomes. Comminuted fractures of the radial head are challenging to treat with open reduction and internal fixation. Radial head arthroplasty is an alternative treatment with results that compare favorably with those reported after open reduction and internal fixation of similar fractures. The purpose of this study was to evaluate the two-year outcomes and the rate of recovery of a closely
and all of the patients with posterior injuries had an associated fracture of the coronoidprocess of the ulna. One of 10 patients with anterior and 13 of 16 patients with posterior injuries had fracture of the radial head. Only one patient had a true dislocation of the ulnohumeral joint. In the other 25 patients the articular surfaces remained apposed. All 26 patients were treated operatively and followed up for at least 3 years (average, 6 years). The results were good or excellent in 21 of 26 (...) patients according to the system of Broberg and Morrey. The five unsatisfactory results were related to inadequate fixation of the coronoid with subsequent arthrosis (three patients), proximal radioulnar synostosis (three patients), and a subsequent fracture of the distal humerus (one patient). Fracture-dislocations of the olecranon occur in anterior and posterior patterns with specific injury characteristics and pitfalls. The key to effective treatment is stable restoration of the trochlear notch.
, Jupiter type IIa fracture, fracture of the radial head, coronoidfracture, and complications requiring further surgery. Bado type II Monteggia fractures, and within this group, Jupiter type IIa fractures, are frequently associated with fractures of the radial head and the coronoidprocess, and should be considered as negative prognostic factors for functional long-term outcome. Patients with these types of fracture should be informed about the potential risk of functional deficits and the possible (...) Monteggia fractures in adults: long-term results and prognostic factors. The objective of this retrospective study was to correlate the Bado and Jupiter classifications with long-term results after operative treatment of Monteggia fractures in adults and to determine prognostic factors for functional outcome. Of 63 adult patients who sustained a Monteggia fracture in a ten-year period, 47 were available for follow-up after a mean time of 8.4 years (5 to 14). According to the Broberg and Morrey
obtained. Each specimen was dissected, and the injury described. A musculoskeletal radiologist, blinded to dissection results, examined the radiographs.Dissection revealed 39 fractures of 96 sites examined. A total of 14 fractures were nondisplaced, 7 involving the coronoidprocess. Radiographs identified 27 fractures. Of the 12 missed fractures, 11 were nondisplaced. Radiographic diagnosis of nondisplaced elbow fractures demonstrated a 21% sensitivity, 95% specificity, 50% positive predictive value (...) Nondisplaced elbow fractures: A commonly occurring and difficult diagnosis. Determine the sensitivity and specificity of radiography in identifying nondisplaced elbow fractures after trauma. Our hypothesis is that nondisplaced fractures occur commonly following impact injuries and are difficult to diagnose with plain film imaging.An in vitro double-blinded study of 16 cadaver arms was designed, simulating axial forearm trauma. Following injury, anteroposterior and lateral radiographs were
Transverse divergent dislocation of the elbow with ipsilateral distal radius fracture in a child. We report a rare case of an irreducible transverse divergent dislocation of the elbow with an ipsilateral distal radius torus fracture and a fracture of the coronoidprocess in a 9-year-old male. Closed reduction of the elbow was attempted, but the humeroulnar joint remained dislocated. At surgery, the avulsed anterior band of the medial collateral ligament complex of the elbow was found
wires directed out the anterior ulnar cortex distal to the coronoidprocess and bent 180degrees and impacted into the olecranon proximally, and two 22- gauge, figure-of-eight, stainless steel tension wires. A single surgeon used this technique for exposure of a fracture (16 patients) or nonunion (29 patients) of the distal humerus in 45 consecutive patients. One patient returned to activity too soon, had loosening of the wire fixation, and required a second operation for plate fixation of the ulna (...) Olecranon osteotomy for exposure of fractures and nonunions of the distal humerus. Although olecranon osteotomy provides excellent exposure of the distal humerus, enthusiasm for this approach has been limited by reports suggesting numerous complications. It has been suggested that specific techniques for creating and repairing an olecranon osteotomy may help limit complications. This paper describes a technique for olecranon osteotomy using an apex, distal, chevron-shaped osteotomy, Kirschner
of the olecranon were treated with temporary hinged external fixation, preservation, or reconstruction of both the coronoidprocess and radiocapitellar contact and with repair or reconstruction of the lateral collateral ligament complex. There were 9 men and 4 women with an average age of 45 years. Seven patients had a terrible triad pattern injury and 6 had a posterior Monteggia pattern injury. All 13 patients had fracture of the radial head and 10 patients had fracture of the coronoid process.At an average (...) Surgical treatment of persistent dislocation or subluxation of the ulnohumeral joint after fracture-dislocation of the elbow. To review the results of surgical reconstruction of posttraumatic elbow instability in the setting of either intact or repaired olecranon process using a protocol incorporating hinged elbow fixation.Thirteen consecutive patients with ulnohumeral instability after a fracture-dislocation of the elbow, adequate articular surfaces, and adequate, stable alignment
and 12 patients had subluxation or dislocation of the ulnohumeral joint. Sixteen patients had fracture of the radial head and 9 patients had fracture of the coronoidprocess. Nine patients had ancillary procedures on the radial head, 4 had ancillary procedures on the coronoid, 5 had hinged external fixation, and one had fascial arthroplasty. Seven patients had another surgery before the final evaluation related to a complication in 6 patients and a to subsequent injury in 1 patient.At the final (...) Loss of alignment after surgical treatment of posterior Monteggia fractures: salvage with dorsal contoured plating. To review the results of internal fixation with a dorsal contoured plate in patients with malalignment after internal fixation of a posterior Monteggia fracture.Seventeen patients with malalignment after surgical treatment of a posterior Monteggia fracture were treated with realignment of the ulna and fixation with a contoured dorsal plate. Fifteen patients had loose fixation