terrible triad
Post on 16-Jul-2015
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FOOSH
Extended elbow
Valgus load
Postero-lateral rotation (relative supination)
Body usually rotates around fixed hand
LUCL fails
Anterior and/or posterior capsule fails
Radio-capitellar dislocation
Radial head shear, fracture
Ulno-humeral dislocation
Coronoid fracture
MCL – last to fail, if it fails
Mason
I: <2mm
II: >2mm, possible block to motion
III: comminuted
Must aspirate and examine sup/pron for Mason II
Observation Mason I
Mason II if no bony block
Radial head resection Contra-indicated in setting of instability!
ORIF Mason III
Mason II with bony block
Radial head replacement >3 fragments
Dislocation
Essex-Lopresti
NV check
Open wounds
Examine the wrist for tenderness
PRLI test
Supine patient, arm overhead
Start in full extension, flex and apply valgus force with forearm in supination
Reduce by pronating and flexing elbow
Hand table
Mini c-arm
+/- sterile tourniquet
+/- head lamp
Hand set
Mini screws
Headless screws
Radial head prosthesis
Hinged ex fix
Suture anchors
Hewson suture passer
Radial head plates
+/- ACL guide
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