Discusión entre pares / 65 female , what do u suggest , also do u think coronoid is fractured ?

Ashutosh Chaudhari

65 female , what do u suggest , also do u think coronoid is fractured ?

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  Manikandan Jeyaprakash Go for proximal ulna lcp

  
  
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  Ashutosh Chaudhari Thanks was planning to use the Synthes olecrenon plate , what about radial head and what do u think about the coranoid

  
  
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  Gopal Goel in the current x ray coronoid does not apear to be fractured. # Prox unla with displaced # neck radius. I would go for excision neck radius + fixation of ulna. At this age i would not think in terms of head prosthesis unless patient wants it

  
  
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  Arvind Jain Coronoid not fractured. increase flexion to achieve reduction.radius head can be excised .

  
  
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  Sudheer Ks K S No coronoid. Radial head excision. Lcp ulna

  
  
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  Ajayakumar Thankappan Orif ulna, use cancellous bone from radial head as bone graft

  
  
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  Animesh Kumar Assess MCL n LCL also. I will suggest, if in doubt, go for CT scan with 3D recon

  
  
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  Animesh Kumar I think the capsule attached over coronoid is avulsed with small bony fragment

  
  
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  Anuj Agrawal There seems to be a tip of coronoid fracture, which would not affect management. I too would go with ulna plating with radial head excision.

  
  
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  Ashutosh Chaudhari i agree with u anuj ,and animesh ,i feel that tip of coronoid is frac ,wondering if thru the rad head exicion portal shoud put a suture anchor and take sutv orv leave alone with slab in more than 90 deg flexion for 3 weeks,any one in favour of radial head replacement ?

  
  
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  Ashutosh Chaudhari anuj would u use a standard lcdcp with cancellous screws or an olecrenon lcp

  
  
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  Kamlesh Dutta Tiwari take xray ap view of elbow in supination and in pronation this will give u additional information.then proceed.

  
  
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  Ashutosh Chaudhari ajaykumar ,that was in my head as well since we will getv a source of cancellous bone

  
  
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  Bharat Durgia OLECRANON HOOK PLATE

  
  
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  Animesh Kumar If cost is not an issue den go for olecranon plate cos with normal plate u will not get 3 screws proximally. U can safely excise radial head. However, I still insist on assesing LCL n MCL n keep sutures anchors, hinged ext fixator, Steinman pin handy

  
  
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  Anuj Agrawal Ashutosh Chaudhari Any plate would do in this case. I would use a standard LCDCP. You will get 3 screws proximally. The bone does not seem to be too osteoporotic to necessitate a locked plate.
  Don't attempt to fix the coronoid piece. Three weeks of immobilization should stabilise the elbow.

  
  
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  Ashutosh Chaudhari Anuj which surface would u plate if I use a dcp then I need to plate one of the sides , instead of post so screws don't enter the joint ( and don't irritate pt ) and we get 6 cortices proximally , she is not porotic , but its a metaphsiodiaphseal junc , so contemplating

  
  
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  Anuj Agrawal I would expose the posterolateral surface of ulna and proximal radius through a single incision (Boyd's approach) and apply the plate laterally.

  
  
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  Ashutosh Chaudhari That was my plan for exposure - boyds , thanks Anuj

  
  
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  Mufazzal Bohra olecronon hook plate will be best for this case as it give extra hold proximally, in TRAUMACON i have seen a custom made olecronon plate made by a surgeon by a surgeon by manipulating low profile semitubular plate by cutting its end hole and giving shape of claw to its end , this pointed 2 spike penetrated prox fragment and then 2 screw are sufficient in prox frag u can try this too

  
  
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  Mufazzal Bohra olecronon hook plate will be best for this case as it give extra hold proximally, in TRAUMACON i have seen a custom made olecronon plate made by a surgeon by a surgeon by manipulating low profile semitubular plate by cutting its end hole and giving shape of claw to its end , this pointed 2 spike penetrated prox fragment and then 2 screw are sufficient in prox frag u can try this too
  olecronon hook plate will be best for this case as it give extra hold proximally, in TRAUMACON i have seen a custom made olecronon plate made by a surgeon by a surgeon by manipulating low profile semitubular plate by cutting its end hole and giving shape of claw to its end , this pointed 2 spike penetrated prox fragment and then 2 screw are sufficient in prox frag u can try this too

  
  
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  Rajasekhar Rao P trust me give a trail of usg for bone healing for 6 wks and then plan what u wan t

  
  
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  Feroz Khan Fracture proximal ulna with radial neck with coronoid.....triad...fix ulna fix radius and fix coronoid. ...if we excise the head will elbow become more unstable?? What does the forum feel

  
  
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  Sadique Ahmed Khan Fix ulna with lcdcp or locked plate.
  Radial head already compltely # n detached just u need to remove.
  Coronoid tip #, nothing to do for that.

  
  
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  Nitin Bhagali Without posterior angulation deformity at the # it is unlikely to have a coronoid #. Synthes olecranon plate, excision head radius needs to be done. I normally transfix inferior R U joint with a K wire to prevent prox migration of radius for 3 wks.

  
  
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  Ashutosh Chaudhari nitin bhagali ,how does that help ,i thought the problem was instability

  
  
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  Rakesh Agarwal fix ulna with whatever pate you like even recon plate will give you good result with proximal screw directed towards upper surface. radius head seems t be comminuted remove it, can go for radial head prostheses if pt affordabl