0:00

So with forearm fracture dislocations, you can think

0:03

of the forearm as having paired bones.

0:06

The radius and ulnar are connected

0:07

by a strong interosseous ligament Displacement of one

0:11

of these bones or a fracture, fragment thereof,

0:13

should be associated with a fracture, dislocation

0:15

of the other bone or disruption of the interosseous ligament

0:19

that connects the two bones.

0:22

So the fracture dislocations about the elbow have

0:25

typical eponyms.

0:26

So we have a montage lesion,

0:28

which is a proximal ulnar fracture

0:30

with radial head dislocation gaze lesions,

0:34

which is now a distal radius fracture

0:36

with distal radial ulnar joint dislocation instability.

0:40

In addition to the elbow fracture

0:43

and Essex rexi lesion

0:44

where you have a comminuted radial head fracture

0:47

with distal radial ulnar joint dislocation and instability.

0:51

So monteer lesions are fractures of the proximal third

0:54

of the ulna associated with a dislocation

0:56

of the proximal radial ulnar joint

0:59

and also the radial Capella joint.

1:02

The direction of the radial head dislocation follows the

1:04

direction of angulation of the ulnar fracture.

1:07

Differential diagnosis would include anterior fracture

1:10

dislocation of the elbow

1:11

that doesn't necessarily disrupt the capsule.

1:14

Monte lesions result in disruption

1:16

of the elbow collateral ligaments in addition

1:18

to the disruption of the proximal radial ulnar joint.

1:21

So mantas lesions can be characterized according

1:25

to the Beto classification.

1:27

So in the Beto classification here,

1:29

type one is the classic montage fracture

1:32

that was originally described with an anterior dislocation.

1:37

Type two is with a posterior dislocation.

1:39

Type three and four have additional fracture dislocations

1:43

and are more complex lesions.

1:46

Essex lopresti injuries demonstrate a fracture

1:49

of the radial head, which is usually combinated

1:51

and displaced in association with dislocation

1:54

of the distal radial ulnar joint.

1:57

So here we have a radiographic example

1:58

of Essex Lopresti lesion

2:01

where thisd proximal radius fracture associated

2:04

with shortening of the radius

2:05

and proximal migration of the distal radial ulnar joint

2:09

as identified on the wrist radiograph.

2:11

So this combination represents radial head fracture plus

2:15

distal radial ulnar joint dislocation,

2:17

and intervening interosseous ligament disruption.

2:21

A gazi injury depicted here is a fracture

2:24

of the distal radial shaft with an associated dislocation

2:28

of the distal radial ulnar joint.

2:30

So with the gazi lesion, the radius fracture is associated

2:34

with dislocation of the distal radial ulnar joint.

2:37

The radial fracture is usually angulated and displaced, and

2:40

therefore there's result in shortening of the radius

2:42

that necessitates

2:44

or causes a dislocation of that distal radial ulnar joint.

2:48

Here's a person who fell on their outstretched hand,

2:51

and here we see a fracture through the proximal alna,

2:54

and this is electron on processs fracture. Here we see a

2:58

Fracture shown on ct, another example

3:02

of a communed fracture of the electron process.

3:05

So there's combintion and fragment displacement,

3:08

which qualifies this as a surgical lesion.

3:11

Here's another example of electron fracture

3:14

where we basically have an avulsion from the triceps.

3:17

So here's the spectrum of adult elbow fractures, radial head

3:21

or neck fractures, about 50% of all comers.

3:24

When you see a OID process fracture, that means

3:26

that a dislocation has occurred

3:28

and it's typically a post dislocation event.

3:31

Capella fractures have that characteristic.

3:34

Inverted appearance, a fracture

3:36

through a LeCron could be displaced or non-displaced.

3:39

Non-displaced communit fractures are a reason

3:42

for surgical treatment.

3:44

And then the distal humerus can also have intercondylar

3:47

fractures in either a T or a Y configuration,

3:51

or a trans condylar fracture,

3:53

which is typically associated with osteoporosis.

3:56

So in the adult, here are some examples

3:59

of condylar fractures.

4:01

Here's our T-shaped fracture.

4:03

Here's an example of a Ys shaped fracture,

4:06

and when it's a little bit more distal to this,

4:09

we can consider a trans condylar fracture as in this patient

4:13

with osteoporosis.