Wednesday, December 17, 2008

"Floating Elbow"

Fracture above and below the elbow joint - making it like a "floating" joint.

The feeling that you get while examining it can be quite scary!


LZ said... did he/she get such injury?

And btw, his/her humerus quite thin huh..

Zzzyun said...

aiyer scary. imagine examining the elbow like the patella!

Yong Chuan said...

Ouch. This is gonna hit a ten on the pain scale huh. MVA i suppose?

Li Ying said...

Was it taken last week? If it is, i think it's my patient...the guy on MB who had MVA with a trailer, rite? Also the left elbow. Can you imagine how floppy it is to hold his upper limb when i'm irrigating the wound?

The radial head and olecranon were staring at me when i opened up the wound...anyway, ulnar nerve completely cut...brachial, radial artery still intact, so the hand is still viable. But the posterior flap is dead dy..may need amputation soon.

confessions of a medical student said...

almost a post everyday! wow! the A&E dept must have been very interesting or you have became very dedicated to blogging... nice to have daily feeds of interesting cases..

Li ying, you said the hand still viable, but why need amputation? i'm a little confused... the cut ulnar nerve, can do a nerve transfer to save it, right? mind to share with us how the patient was managed and how is his condition now? thanks :)

Li Ying said...

Distal to the injury, the hand is still viable. But the whole piece of skin and muscle overlying the elbow joint posteriorly is non viable anymore..besides the ulnar nerve cut, all the extensor muscles over the left arm were cut, meaning the blood supply to that posterior flap was cut off too.

The stinky smell of dead rotten meat and pale looking, non-bleeding, non-contractile muscles there (when we opened up 3 days later for wound debridement) is a sign of infection and non-viability..

If the infection gets too bad, amputation is the only choice...coz if u keep on cutting away the dead muscle, there'll be nothing covering the bones over the elbow jt.

P.S.: The proximal part of the ulnar nerve was unable to be found in the first operation..and will not be reconnected if infection is present. The last I saw him was in ICU on sunday.

- yuhhui - said...

Wow. I feel his pain. Gosh.

Darren Lee said...

LY, ya this is the case that was admitted to ortho ward.

A bad MVA can cause all types of fractures!
But I think in such situation, being able to feel the pain is better than the other way round. Get what i mean?;)

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