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Extensile Surgical Exposures: Humerus

Introduction Occasionally, it becomes necessary to perform extensile surgical exposures to the humerus for trauma, malignancy or revision elbow surgery with periprosthetic fracture, or severe and significant bone loss where allograft prosthetic composites are planned. In this chapter, we will cover the three most utilitarian approaches to the humerus, including the extensile anterior lateral approach, the extensile posterior medial approach, and the posterior triceps-splitting approach. All…

Ultrasound Imaging of the Elbow

Introduction Ultrasound (US) has continued to evolve to become an extremely useful diagnostic imaging modality in the detection of various soft tissue pathologies around the elbow: tendons, ligaments, and nerves. The superficial location of the elbow allows for excellent high-resolution imaging of subcutaneous and periarticular structures utilizing high-frequency linear array transducers. Although there is an initial learning curve, and diagnostic accuracy remains operator dependent, the wide…

Magnetic Resonance Imaging of the Elbow

Introduction Magnetic resonance imaging (MRI) has gained wide acceptance as a complementary tool in the diagnosis of disorders of the musculoskeletal system, largely due to its excellent depiction of soft tissues. Within the past decade, MRI at 3 T has become widely available and has shown promise in increasing diagnostic accuracy because of its inherently increased spatial resolution. Technique Although a detailed review of the technical parameters…

Computed Tomography of the Elbow

Introduction Extensive research and development in CT in the past decade have yielded significant enhancements in image acquisition and processing efficiency, image resolution, and reconstruction capability, as well as artifact reduction capacity. Although radiographs, MRI, and ultrasonography have broader clinical utility in the evaluation of elbow disease, the recent advances in CT technology have solidified CT as a powerful investigative tool for several clinical settings in…

Radiography of the Elbow

Introduction Plain-film radiography remains standard in the evaluation of the elbow. A radiographic series, including anteroposterior (AP), oblique, and lateral projections, provides valuable information about the bone, joints, and soft tissues. They are a mainstay for fracture evaluation and often guide the subsequent acquisition and interpretation of advanced imaging. Advanced imaging is often reliant on plain radiographs for accurate interpretation. This chapter discusses the techniques and…

Functional Evaluation of the Elbow

Introduction Elbow function consists of three elements: (1) positions the hand in space, (2) stabilizes the upper extremity linkage, and (3) generates power to perform lifting activities. The essential joint functions that form the basis of functional assessment strategies are motion, strength, and stability. Ultimately, however, the final determinant of function is the ability to perform activities of daily living, and the principal determinant of this…

History and Physical Examination of the Elbow

Introduction This chapter deals with the basics of a general comprehensive history and physical examination of the elbow. Specific and focused features of the history and examination are pictured with the various conditions described in the following sections. History Without question, the value of a precise history cannot be overstated. Pain is the most common complaint. The location, quality or type, context in which the pain…

Biomechanics of the Elbow

Introduction The very basic function of the upper extremity depends largely on a functional elbow joint. A complex joint, the elbow, serves as a link in the lever arm system that positions the hand, as a fulcrum of the forearm lever, and as a load-carrying joint. Loss of function in the elbow, possibly more than that in any other joint, can jeopardize individual independence. In our…

Anatomy of the Elbow Joint

This chapter discusses the normal anatomy of the elbow region. Abnormal and surgical anatomy is addressed in subsequent chapters of this book dealing with the pertinent condition. Topical Anatomy and General Survey The contours of the biceps muscle and antecubital fossa are easily observed anteriorly. Laterally, the avascular interval between the brachioradialis and the triceps, the so-called column, is an important palpable landmark for surgical exposures…

Phylogeny

Introduction The human elbow forms the link between brachium and forearm, controlling length of reach and orientation of the hand, and is one of our most distinctive anatomic regions. An appreciation of elbow phylogeny complements anatomic knowledge in three ways: (1) it demonstrates how the elbow has evolved to facilitate specific functional demands, such as suspensory locomotion and dexterous manipulation; (2) it explains the functional significance…

Cervical Spine Traction With Gardner-Wells Tongs

Overview 1. Cervical spine traction is accomplished with placement of calipers or tongs to the skull and attachment to a pulley system secured to a bed. 2. Although a wide variety of tongs exist, Gardner-Wells tongs are the most frequently used and the most frequently available. Gardner-Wells tongs consist of a hoop attached to two 30-degree angled pins. Indications for Use 1. Subaxial cervical fractures that…

Calcaneal Skeletal Traction

Overview Calcaneal traction is accomplished with placement of a pin across the posterior aspect of the calcaneus and attachment to a pulley system secured to a bed. Indications for Use Tibial shaft fractures You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Tibial Skeletal Traction

Overview Tibial traction is accomplished with placement of a pin across the proximal tibial metadiaphysis and attachment to a pulley system secured to a bed. Indications for Use Femoral shaft fractures You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Femoral Skeletal Traction

Overview Femoral traction is accomplished with placement of a pin across the distal femur and attachment to a pulley system secured to a bed. Indications for Use 1. Acetabular fractures 2. Proximal femur fractures You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Lower Extremity Splints and Casts

Hip Spica Cast Overview 1. A hip spica cast is one of the most difficult casts to apply. 2. It is generally composed of an abdominal portion attached to a long leg cast, which is a so-called “double spica cast.” When the unaffected extremity is placed into a thigh-only cast, the cast is termed a “1½; spica cast.” A “single leg” hip spica cast is composed…

Upper Extremity Splints and Casts

Figure-of-8 Splint Overview 1. Figure-of-8 splints are primarily used for fractures about the clavicle. 2. Figure-of-8 splints are commercially prepared devices intended to create a reduction force on the clavicle. 3. No difference in outcome is seen between a figure-of-8 splint and a sling for closed management of clavicle fractures. Indications for Use 1. Minimally displaced clavicle shaft fractures 2. Medial physeal clavicle fractures Precautions 1.…

Basics of Splinting and Casting

Basic Principles First, Do No Harm 1. Make sure that the potential complications of applying and maintaining a cast or splint are less severe and are less likely than the complications of an untreated injury. 2. A poorly made splint/cast can result in pressure sores, compression neuropathies, joint stiffness, and complex regional pain syndrome. 3. Never place a circumferential rigid dressing (cast) over an increasingly edematous…

Pelvis and Lower Extremity Reduction

Pelvis Reduction Overview 1. Application of a pelvic binder is a key step in the initial management of an unstable pelvic fracture. 2. Commercial pelvic binders are available, or a simple bedsheet may be used as a pelvic binder. 3. Venous bleeding is the most common cause of hemorrhage in a patient with hemodynamic instability and an unstable pelvic fracture. 4. By applying a binder, stability…

Forearm, Wrist, and Hand Reduction

Forearm Fractures Overview 1. Fractures of both bones of the forearm ( Fig. 10.1 ) should be anatomically reduced (except in children younger than 12 years) to preserve forearm rotation. a. Only accept as much deformity as can be remodeled in 1 year. b. In children younger than 8 years, bayonet apposition and 20 degrees of angulation are acceptable. c. In children older than approximately 8 years, length should be restored…

Shoulder and Elbow Reduction

Clavicle Fractures Overview 1. Most clavicle fractures require no reduction. 2. Closed reductions cannot be maintained and should not be attempted. Indications for Use 1. Minimally displaced clavicle shaft fractures ( Fig. 9.1 ) 2. Medial physeal clavicle fractures Precautions Do not attempt heroic measures to reduce clavicle fractures. Pearls 1. Clavicle fractures with more than 1.5 cm of overlap result in long-term disability and should be…