Q: 7F, FALL FROM 10 FT: OBVIOUS LEFT ELBOW DEFORMITY: HOW WOULD YOU MANAGE IT?
A: ATLS protocol. Lifesaving before limb saving.
Trauma/fall, pain, swelling, +- cold limb (cyanotic looking)
Distress, swelling, +- cyanosis, thorough NV check, especially AIN and radial artery.
- Check Baumanns angle (line through the ossification centre of lateral epicondyle vs perpendicular line subtending the ant humeral line)
- Ensure radial head pointing to capitellum in all views: if not: its lat condyle fracture or Monttegia)
Gartland 1: Minimally displaced
Gartland 2: Posteror cortex intact
Gartland 3: Complete disruption
If NV intact: Analgesia, XR AP and Lateral, backslab for comfort.
Gartland 1: Rx backslab, post slab views: Rv clinic 1 week: change to full cast: 2-3 weeks: then ROM exercise.
Garland 2: For 2 Low threshold to Rx as 3
Gartland 3: Mark and consent (main guardian for pt) – MUA + K wire.
For an appropriately marked and consented pt:
Preplanning/templating/ Team brief/ WHO check list.
Supine, arm board. With tourniquet.
MUA: Traction (forearm/ countertraction upper arm), reduce valgus or varus deformity and concurrently apply anterior pressure on olecronon, then hyperflex elbow. Check I/I: confirm adequate ant humeral line and radial head facing capittelum
1.6 or 1.8 mm retrograde K wires from lateral epicondyle: divergent at fracture site: distal lateral to proximal medial (bicorticol): gives enough stability, 3rd can be added medially: mini open: ensure ulnar not trapped.
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