APEX Elbow Mastering Surgical Techniques for Clinical Success-Complex Elbow Trauma

Video Transcription

Video Summary

The speaker leads a pragmatic case-based discussion on complex elbow trauma, emphasizing subtle injury patterns and treatment decision-making. Case 1 involves a 39-year-old with elbow dislocation and an apparent radial head fracture; CT/3D reconstructions reveal an easily missed supinator crest fracture (LUCL avulsion). The group discusses when CT is needed, nonoperative criteria for radial head fractures (no mechanical block, minimal displacement), and operative strategies. Fixation is performed through a posterior-based approach with separate windows; the supinator crest is secured with sutures/anchor cerclage plus a screw, and the radial head is fixed with small screws after K-wire provisional fixation.<br /><br />Case 2 is a “terrible triad” pattern (dislocation, radial head fracture, small coronoid). Debate centers on whether to fix small coronoid fragments; the speaker is aggressive about coronoid/capsule repair (suture lasso) to allow early motion, while emphasizing LUCL repair and radial head replacement when needed, avoiding overstuffing.<br /><br />A final case highlights a pitfall: an unstable “simple” dislocation after pedestrian trauma was actually an internal degloving with perforator loss. A posterior incision led to severe skin necrosis, underscoring vigilance for vascular compromise and considering less disruptive stabilization (e.g., pins) in such scenarios.

Asset Caption

Moderator: William Aibinder, M.D.

Keywords

complex elbow trauma

elbow dislocation

radial head fracture fixation

LUCL avulsion (supinator crest fracture)

terrible triad elbow injury

coronoid fracture and capsule repair