How to Tame the Terrible Triad of the Elbow Michael D. McKee, MD, - - PowerPoint PPT Presentation

how to tame the terrible triad of the elbow
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How to Tame the Terrible Triad of the Elbow Michael D. McKee, MD, - - PowerPoint PPT Presentation

How to Tame the Terrible Triad of the Elbow Michael D. McKee, MD, FRCS(C) Professor and Chair, Department of Orthopaedic Surgery University of Arizona, College of Medicine, Phoenix, AZ Bony structures Bony congruity


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SLIDE 1

How to Tame the Terrible Triad

  • f the Elbow
  • Michael D. McKee, MD, FRCS(C)
  • Professor and Chair, Department of Orthopaedic Surgery
  • University of Arizona, College of Medicine, Phoenix, AZ
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SLIDE 2

Bony structures

  • Bony congruity
  • Coronoid process
  • Radial head
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SLIDE 3

SOFT TISSUE STRUCTURES

  • Lateral (ulnar) collateral

ligament

  • lateral epicondyle to tubercle
  • f supinator crest on lateral

side of ulna

  • posterior bundle most

important

  • common injury in elbow

dislocation

  • resists varus and rotational

stress

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SLIDE 4

SOFT TISSUE STRUCTURES

  • Medial (ulnar) collateral ligament
  • medial epicondyle to tubercle on medial

aspect of coronoid

  • Anterior band

most important

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SLIDE 5

Stability

  • The coronoid
  • The lateral collateral ligament
  • The radial head
  • The medial collateral ligament
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SLIDE 6
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SLIDE 7
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SLIDE 8

Surgical tactics

  • Fix coronoid or repair anterior capsule
  • Fix or replace the radial head (metallic,

modular)

  • Repair the lateral collateral ligament / CEO
  • Repair the medial collateral ligament
  • Apply a hinged fixator
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SLIDE 9
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SLIDE 10
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SLIDE 11
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SLIDE 12

฀Coronoid fixation

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SLIDE 13

ORIF / Replacement radial head

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SLIDE 14

Avulsion from lateral condyle

McKee et. al. JSES 2003: pathoanatomy of lateral ligament disruption in complex elbow instability.

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SLIDE 15
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SLIDE 16
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SLIDE 17
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SLIDE 18

Surgical technique

1) Radial head fracture - ORIF 14

  • replacement 23
  • fragment excision 4

2) Coronoid fracture - ORIF 18 capsule repair 23 3) Soft-tissue repair - LCL (+/- CEO) 41

  • MCL 6

4) Hinged external fixator - 9

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SLIDE 19

Results

  • Mean follow-up 14 months
  • Mean flexion-extension arc 109˚
  • Mean forearm rotation arc 127˚
  • Mean Mayo elbow score: 89

(19 excellent, 14 good, 7 fair, 1poor)