elbow trauma clinical cases

• No – I would make a plan based on what I can see
• Yes, I would do a CT +/- 3D reconstruction
• No, I would take the patient to theatre based on what I can see, undertake fluoroscopy / examination under anaesthesia and finalise the surgical plan on the table
• None of the above
• A combination of the above

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• Isolated radial head fracture
• Terrible triad injury
• Essex-Lopresti injury

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• Undertake an MRI of the forearm or wrist before proceeding?
• Skip the MRI in favour of a dynamic assessment of the radius in theatre
• Stick to the original plan of fixing or replacing the radius?
• Consider additional procedures?
• A combination of the above?

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• I think that the radial head is salvageable and I’m planning to fix it with a plate
• I think that the radial head is salvageable and I’m planning to fix it with headless screws
• I don’t think the head is salvageable and I will plan a possible radial head replacement .
• Radial head replacement alone is not sufficient so I will plan an acute interosseous ligament reconstruction
• Acute interosseous membrane reconsruction is overkill. At the end of the case I’ll examine the DRUJ and maybe do a TFCC repair.
• I don’t want to reconstruct the IOM or do a TFCC repair. If the DRUJ is stable, I’ll just pass a wire across the DRUJ and keep the patient in an above elbow cast for 6 weeks and go from there.
• A combination of the above

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• This is a simple dislocation with coronoid tip fracture.
• This is a ‘Terrible Triad’ fracture dislocation.
• I can’t tell yet and would like more imaging.

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• Reduce the fracture in ED, send home, keep in backslab and see again in fracture clinic in 2 weeks.
• Reduce the fracture in ED, no backslab required, encourage mobilisation, refer to physio, see in fracture clinic in 2 weeks.
• Reduce the fracture in ED, urgent CT scan, refer to orthopaedics and review in clinic in 24 to 48 hours.
• Reduce the fracture in ED, urgent CT scan and book for theatre. This will definitely need surgery.

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• This is predominantly a bony problem with only minimal soft tissue involvement.
• The lateral ligament complex is likely to be injured.
• The medial collateral ligament is likely to be injured.
• Both lateral and medial ligaments are likely to be injured.

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• I’d get this elbow going as soon as possible to avoid stiffness. Early mobilization only. No surgery required for this injury.
• I’d definitely fix the radial head and lateral ligament complex but leave the coronoid and medial side – I don’t think these don’t need surgical repair.
• The radial head fracture is insignificant and can be treated non-surgically. I’m more concerned about the coronoid fracture and would fix this from the medial side.
• I’d fix the radial head and lateral ligament complex. I would also plan to fix the coronoid and repair the medial collateral ligament.

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• AP xray
• CT scan
• MRI
• All of the above

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• Yes
• No

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• Tip
• Anteromedial facet
• Both

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• Yes
• No

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• Tip
• Anteromedial facet
• Both

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• Patient A & B non operative management
• Patient A operative management, Patient B non-operative management
• Patient A non-operative management, Patient B operative management
• Patient A & B operative management

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• Anterior
• Anteromedial
• FCU split
• Hotchkiss ‘over the top’

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