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Orthopedics 5th year, 5th lecture (Dr. Ali A.Nabi)
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The lecture has been given on Apr. 13th, 2011 by Dr. Ali A.Nabi.
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Can read freely here https://sethiortho.blogspot.com/ Challenges and Solutions in Management of Distal Humerus Fractures Epidemiology Anatomy Classification Controversies and Recent studies Approach Implants selection Plate configuration Ulnar nerve transposition Role of total elbow arthroplasty in DHF Role of hemiarthroplasty in DHF Metaphyseal comminution – Anatomic complexity of the distal humerus Positioning of the plates TBW – Skin closure Osteoporotic nature of the bone – Less BMD/Thin metaphysis Screw Pullout strength is low DHF account for 2% of all adult fractures The common pattern of fracture Intraarticular and involves both columns Bimodal distribution Peak incidence in young male and in older female patients Young male – High-velocity injury Older female - Osteoporosis The distal humerus is flattened and expanded bony structure It is composed of lateral and medial columns with the trochlea situated between these columns. The location of the trochlea is central rather than medial Formed by Medial SCR + M/Epicondyle The distal end has 450 angulation with humeral shaft M/ Epicondyle gives attachment for MCL & Common Flexor Origin The MCL originates from the undersurface of the medial epicondyle where it is vulnerable to excessive dissection Ulnar nerve Formed by Lateral SCR and L/Epicondyle and Capitulum Distal end has 200 with humeral shaft L/ epicondyle gives attachment for LCL & common extensor origin Its posterior surface is non articular and can be used as a site for a plate fixation The lateral column curves anteriorly Placement of a straight plate on the posterolateral surface of the humerus risks straightening of distal humerus. The medial column including the medial epicondyle is in line with the humeral shaft. It forms the center of the triangle It has 30 - 80 – external rotation & 250 anterior divergent with the shaft It forms a 40 - 80 degree valgus direction X-ray - Anterior-posterior view lateral View Traction View – This can help to define articular fragments and aid in pre-operative classification of the fracture. NCCT – Elbow Articular surfaces Position of the fracture fragments useful for identifying impacted fracture fragments that make reduction challenging Olecranon Osteotomy Approach – 52-57% Triceps sparing VS Olecranon osteotomy approach The lateral column was often the first to fail as a result of excessive varus forces acting on the elbow during normal activities of daily living. Small anterior-posterior diameter Smaller diameter of the humerus, permitting only one or two short screws for fixation. Interruption of blood supply to the lateral column blood supply to the lateral column is also derived from posterior segmental vessels. Sagittal plane plating has less risk of injuring these structures, which may improve the chances of union
Distal Humerus Fractures.pptx
Distal Humerus Fractures.pptx
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Can read freely here https://sethiortho.blogspot.com/ Challenges and Solutions in Management of Distal Humerus Fractures Epidemiology Anatomy Classification Controversies and Recent studies Approach Implants selection Plate configuration Ulnar nerve transposition Role of total elbow arthroplasty in DHF Role of hemiarthroplasty in DHF Metaphyseal comminution – Anatomic complexity of the distal humerus Positioning of the plates TBW – Skin closure Osteoporotic nature of the bone – Less BMD/Thin metaphysis Screw Pullout strength is low DHF account for 2% of all adult fractures The common pattern of fracture Intraarticular and involves both columns Bimodal distribution Peak incidence in young male and in older female patients Young male – High-velocity injury Older female - Osteoporosis The distal humerus is flattened and expanded bony structure It is composed of lateral and medial columns with the trochlea situated between these columns. The location of the trochlea is central rather than medial Formed by Medial SCR + M/Epicondyle The distal end has 450 angulation with humeral shaft M/ Epicondyle gives attachment for MCL & Common Flexor Origin The MCL originates from the undersurface of the medial epicondyle where it is vulnerable to excessive dissection Ulnar nerve Formed by Lateral SCR and L/Epicondyle and Capitulum Distal end has 200 with humeral shaft L/ epicondyle gives attachment for LCL & common extensor origin Its posterior surface is non articular and can be used as a site for a plate fixation The lateral column curves anteriorly Placement of a straight plate on the posterolateral surface of the humerus risks straightening of distal humerus. The medial column including the medial epicondyle is in line with the humeral shaft. It forms the center of the triangle It has 30 - 80 – external rotation & 250 anterior divergent with the shaft It forms a 40 - 80 degree valgus direction X-ray - Anterior-posterior view lateral View Traction View – This can help to define articular fragments and aid in pre-operative classification of the fracture. NCCT – Elbow Articular surfaces Position of the fracture fragments useful for identifying impacted fracture fragments that make reduction challenging Olecranon Osteotomy Approach – 52-57% Triceps sparing VS Olecranon osteotomy approach The lateral column was often the first to fail as a result of excessive varus forces acting on the elbow during normal activities of daily living. Small anterior-posterior diameter Smaller diameter of the humerus, permitting only one or two short screws for fixation. Interruption of blood supply to the lateral column blood supply to the lateral column is also derived from posterior segmental vessels. Sagittal plane plating has less risk of injuring these structures, which may improve the chances of union
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Distal Humerus Fractures.pptx
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Orthopedics 5th year, 5th lecture (Dr. Ali A.Nabi)
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Intertrochanteric fractures
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Subtrochanteric fractures
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![Intertrochanteric fractures ,[object Object],[object Object],[object Object],[object Object]](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)