0:01

So once again, uh, I'm going to put up my coronals.

0:05

Now, in that last case,

0:07

I'm gonna flip them over a little bit since I know a lot of,

0:10

you're used to seeing them this way, like an AP radiograph

0:14

of the, of the elbow.

0:17

You know, in that last case, uh,

0:20

I would've made the diagnosis

0:22

of an elbow subluxation dislocation,

0:25

and then I would've listed the individual ligaments

0:28

that were torn and intact.

0:30

And I've als I also would've had a bone line in my

0:34

conclusion to say where the microtrabecular injuries were

0:38

and that there weren't any macro fractures.

0:41

So now we're, we're headed towards a, a,

0:43

a younger individual.

0:44

This is a 13-year-old who complained

0:47

after falling on an, on an outstretched arm during a,

0:51

a wrestling match.

0:52

So let's take a look at this one.

0:55

Um, let me put up my sagittal on the far right.

1:01

Uh, it's a little, little motion, but I think sufficient.

1:05

We'll blow it up. We'll blow this one up.

1:08

And this one, and this is a pretty easy one to end with.

1:13

Um, this time we do have a,

1:17

a significant bone injury.

1:19

We've got a, at least a microtrabecular, intramedullary

1:23

and chondral bone fracture of the radius.

1:26

The radial head is also involved. It's emus.

1:29

You look at the T one weighted image, uh, the degree

1:32

of deformity is mild.

1:35

And then let's, uh, there,

1:37

there's another little synovial fringe right there.

1:40

Let's look at our proper collateral ligament,

1:43

which is intact.

1:44

Let's go more posterior

1:46

to find our lateral ulnar collateral ligament,

1:49

which is also intact.

1:51

Some of likened it to the shape of a funnel.

1:54

And it does look a little bit like a funnel right there.

1:58

We've got our, uh, slight

2:01

disparity in the relationship between the radius

2:05

and ulna and the humerus.

2:07

I like to see the humerus over just a little bit further

2:10

towards the midline.

2:12

And this is, this area right here is slightly deformed.

2:15

So it looks like it gives the appearance

2:17

that the radius is hanging out

2:19

because we've got a little bit

2:20

of depression over here at another site

2:23

of microtrabecular fracture.

2:25

But this hearkens back to my discussion earlier.

2:28

I like to see in a valgus injury

2:33

kissing abnormalities in the Capella and the radius.

2:38

Not so much eccentric up here, like that other case

2:41

where there was a direct blow

2:43

to the lateral aspect of the elbow.

2:45

And I use these bone findings to create a story

2:49

and it's all about the story.

2:51

So let's look at the medial collateral ligament,

2:54

which has been placed under stress.

2:57

We know that because we have impacted the lateral aspect

3:01

of the radius and Capella

3:03

and we have a floating medial collateral ligament.

3:08

The distal portion, which should attach

3:10

to the sublime tubercle

3:12

and have virtually no recess in a 13-year-old is torn.

3:16

The proximal aspect of it is, is clearly torn while

3:21

the apophysis is intact

3:24

and the common flexor is intact over to the lateral side.

3:28

The common extensor is intact.

3:31

And then you'd go through your process of checking all the,

3:35

all the other tendons and ancillary ligaments.

3:38

So my conclusion in this case would be

3:41

valgus mechanism of injury.

3:43

And then I put a semicolon, number one rupture

3:47

of both the proximal

3:48

and distal aspects of the anterior bundle

3:51

of the medial collateral ligament.

3:54

Number two, intact lateral collateral ligaments

3:58

number three, and then I'd list the bone abnormalities.

4:04

Don, any comments on this

4:05

Case? No, no, other than

4:06

to emphasize, again, uh, not just

4:09

for the elbow joint,

4:10

but for all joints, the patterns of bone contusions

4:14

or fractures are often the most important aspect of trying

4:19

to figure out a mechanism of injury.

4:22

Uh, I use it particularly for knee injuries,

4:25

but also obviously for injuries of other joints.

4:28

And I would agree, when dealing with a valgus injury,

4:31

you're looking for signs of compression

4:34

of two bone surfaces about the knee.

4:37

Sometimes not.

4:38

Both surfaces are involved even though they hit each other.

4:42

Sometimes, um, the tibial side tends

4:45

to be involved more than the femoral side.

4:47

So even in this case, we have both sides involved.

4:51

Sometimes you don't, you're not lucky enough

4:53

to have both sides involved.

4:54

Sure, and especially with translation.

4:56

You know, you may have non kissing abnormalities.

4:59

And before we leave this case,

5:01

there's some very elegant anatomy.

5:03

Here. We see the posterior UCL there,

5:07

the roof of the cubital tunnel.

5:08

The transverse bundle. So here's your cubital tunnel.

5:11

There is your ulnar nerve

5:12

and there is your, your superficial osborne's fascia.