Saturday, March 8, 2014

Elbow Relocation

Elbow Relocation maneuver in the following video:

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Stage 1:
ulnar lateral collateral ligament disruption with or without disruption of the remaining lateral collateral ligament
results in posterolateral rotatory subluxation that reduces spontaneously
positive lateral pivot-shift
Stage 2: Elbow subluxation
Additional anterior and posterior soft tissue disruption
elbow subluxes so that the coronoid is perched under the trochlea
Stage 3: Elbow dislocation
Stage 3a: Anterior band of MCL is intact. Elbow is stable to valgus stress test after reduction
Stage 3b: Anterior band of MCL is ruptured and elbow is unstable to valgus stress after reduction
Stage 3c: All soft tissues stripped from distal humerus; Elbow grossly unstable from 0-90 degrees, even after splinting or casting. Stable when flexed to greater than 90 degrees. If there is no associated fracture of the coronoid or radial head, displacement may be severe and sudden once the coronoid and radial head have cleared the distal humerus, leading to extensive soft tissue tearing. Typically the common flexor and extensor tendons are torn as well. However, fractures of the radial head and coronoid (terrible triad injury), when present, absorb energy in progression and the elbow dislocates and displacement (and secondary soft tissue tearing) may be less severe.



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