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Okay, now I wanna show you initially what we will call

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fractures first, dislocations second.

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'cause if you look at this anatomy of the elbow joint,

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and I'm showing it diagrammatically on the left, owing

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to the trochlea

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and the trochlea notch, many of the vectors

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that could be applied to the elbow region at the time

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of an injury will in fact first produce a fracture

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and then a displaced fracture, which we often call a

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fracture dislocation.

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Let me show you some examples.

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I'm gonna start here with an elbow that is flexed

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and show you what happens if we apply axial compression

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alone to this particular elbow.

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The first thing that's going to occur is going to be this

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fracture of the icreon, and then with severe force,

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or over time displacement may occur

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and we end up with a icreon fracture, first

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dis displaced fracture or dislocation.

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Second. So this is not a pure elbow dislocation.

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This is a fracture with displaced fracture fragments.

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This is a common pattern of injury to the elbow.

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Let's do this again, axial compression.

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But now we'll apply the force along the long axis

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of the forearm.

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The first thing that is going to occur is going

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to be a fracture of the OID process.

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It may involve also the radial head.

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Then what's going to occur is a, a name

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of a disorder that is called a OID fracture dislocation.

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And this, as I've illustrated, is the terrible triad

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of the elbow, A dislocation,

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but it's really a fracture dislocation

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with displaced fracture fragments, a coronoid process

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fracture, and a radial head fracture.

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So fracture first, dis fracture, fragments

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or dislocation.

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Second, let's look at valgus force.

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And I'm gonna apply it to an elbow that is in extension.

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So here it goes. Here's the valgus force.

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And what do we see? We may get ligamentous problems

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medially, but all of the fractures that are occur

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generally are laterally involving the Capella,

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the radial head, the lateral condyle,

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and epicondyle may be involved.

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So this is the initial injury.

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And then over a period of time, a posterior

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or posterolateral fracture, first dislocation

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or displaced fracture fragments.

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Second, and I wanna emphasize that

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because I think since the term fracture dislocation is used

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for these injuries,

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I think it gets confusing when you're trying

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to learn about elbow dislocation.

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There are two rotational forces that may lead

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to elbow subluxation,

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or in some cases elbow dislocation

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without a major fracture.

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The first of these, which I'm showing with this drawing,

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is a valgus posterolateral rotary instability pattern,

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designated PLRI

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or V-L-P-R-L-R-I.

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And what occurs that during this injury are three steps

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that we'll talk about with external rotation of the forearm.

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The second, which is more recently described,

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but equally important, relates to internal rotation

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of the forearm with varus

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and its designated var postal medial rotary instability.

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Now with PLRI, you can get an elbow dislocation

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with without any fracture,

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although a fracture doesn't eliminate that diagnosis.

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With this postal medial, uh, rotary instability

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or PMRI, typically you'll get elbow subluxation,

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not this location with one fracture,

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which doesn't look like a major fracture,

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but it is an important one and we're gonna emphasize it.

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So we're gonna look through these particular patterns.