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MASON CLASSIFICATION
NON-OP TREATMENT
Indications:
Mason 1 Mason 2
Tx: Sling for comfort Immobilization no more than 2 weeks to prevent elbow stiffness! Fracture displacement and nonunion is usually asymtomatic and inconsequential
(Ring - CORR 2002, Cobb Orthopedics 1998)
OPERATIVE INDICATIONS
Traditionally
1) >2 mm displacement 2) >30% of joint involvement
OPERATIVE TX OPTIONS
ORIF
Mason type 2: 15/15 had satisfactory result Mason type 3 with 2-3 fragments: 1/12 nonunion Mason type 3 with >3 fragments: 13/14 had unsatisfactory results
(Ring JBJS Am 2002)
ARTHROPLASTY
N=16 80% good or excellent results at 2.8y f/u Early mobilization important for satisfactory outcome
(Bain JBJS Am 2005)
SURGICAL ANATOMY
Pronation of forearm translates PIN 1 cm away from operative field Safe zone of lateral radius: Proximal 38 mm Supination decreases safe zone to 22 mm
(Diliberti JBJS Am 2000)
CORONOID FRACTURES
CORONOID FRACTURES
Type 1: Sutures around the fragment Type 2: Sutures through drill holes in ulna Type 3: Screws Small fragments associated with more challenging injury pattern!
ELBOW DISLOCATIONS
ELBOW STABILIZERS
ELBOW DISLOCATION
Non-op or Radial head excision + Cast Good results if no coronoid fracture Radial head was ultimate determinant of outcome with many radial head resections needed to restore forearm rotation
(Broberg & Morrey CORR 1987)
TERRIBLE TRIAD
CURRENT MANAGEMENT
Radial head ORIF or arthroplasty Coronoid fixation
CROSS PINS
EX-FIX
HINDGED BRACE