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CASE

CASE PRESENTATION




Patient - ‘X’
Age - 39 years/ Male
Date of Admission: 08/09/2016
Date of Surgery: 13/09/2016

Patient has restricted elbow movements and inability to use Left elbow since 1week.

Patient has restricted elbow movements and inability to use Left elbow since 1week. Patient gave history of slip and fall, while tried to catch the bus. Since then patient complaints of pain, swelling, range of movements restricted.
After the injury patient went to the nearby hospital. In the hospital patient has been taken to the emergency department. There was a mild abrasion over the elbow, no any severe bleeding or deep wound is noticed over other parts of the body. Patient treated conservatively, patient had no relief.
Patient came to our hospital for further management. X-ray taken and it showed Coronoid process fracture with displacement. Above elbow (AE) slab has been given.

According to REGAN & MORREY classification: which is based on height of the coronoid fragment. TYPE III – Fracture greater than 50% of coronoid process height. According to REGAN & MORREY classification: which is based on height of the coronoid fragment. TYPE III – Fracture greater than 50% of coronoid process height.

According to O’ Driscoll classification: TYPE III - BASAL; SUBTYPE 1- CORONOID BODY & BASE.

  • Previous Injury: No
  • Developmental History: No any developmental histories
  • Drug History: No known drug allergies. Not on any chronic medication.
  • Past Medical History: No DM; No HTN; No Asthma; No thyroid disease.
  • Past Surgical History: No and No any blood transfusion.

Patient is conscious, oriented.
Vital Signs

  • BP – 130/80 mmHg
  • PR – 80/min
  • SPO2 – 98%

  • Pain and Swelling over the Left Elbow is present.
  • Tenderness and Crepitus over the Left Elbow is present
  • Range of Motion of Left Elbow is restricted
  • Any attempted movements painful.
  • Active finger movements present.
  • Radial pulse present

The patient is supine position. The arm is abducted, supported on a padded table for upper extremity surgery. The elbow is extended and the forearm supinated. The tourniquet is placed around the upper arm and inflated at the surgery’s discretion.

A curved incision over the anterior aspect of the elbow is performed 5 cm above the flexion the flexion crease on lateral side of biceps.

Curvi-linear incision over the front of the elbow. It ends on the medial border of the brachio-radialis.

Identify and protect the Posterior Interosseous branch (PIN) of the medial nerve at the lateral margin of the brachial muscle, carefully follow it to the supinator muscle. Split the fascia and ligate the recurrent radial artery.

Further deep dissection exposes the bicipital tuberosity of the radius. Reflect the supinator carefully protecting the PIN, to display the tuberosity.