Coronoides medellin mayo 2015
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Transcript of Coronoides medellin mayo 2015
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CORONOIDES
Medellin 8 mayo2015
Meisser Alberto López CórdobaCirugía de Mano y Miembro Superior
UdeA - HUSVF - GEMS
GEMS
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2-10 % en Lx de codo
Muy rara Ubicación
estratégica Tendencia
Qx Entendemos
mas….
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Anatomia
Estabilizador primario (varo)
Inserción muscular Lig colat. Medial
Wake H, Hashizume H, Nishida K, et al. Biomechanical analysis of the mechanism of elbow fracture-dislocations by compression force. J Orthop Sci 2004;9(1):49;
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Anatomia
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Anatomia
Proceso coronoideo
Fractura Fasciculo Anterior
LCM
Fasciculo posterior
LCMTubérculo sublime
Fasciculo Anterior
LCM
Ligamento
anular
Fractura
LCL
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Anatomia
Reichel L M, Milam G S, Hillin C D, Reitman C A. Osteology of the coronoid process with clinical correlation to coronoid fractures in terrible triad injuries. J Shoulder Elbow Surg (2013) 22, 323-328
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Diagnóstico…
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Imágenes diagnósticas
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Imágenes diagnósticas
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Imágenes diagnósticas
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Imágenes diagnósticas
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Imágenes diagnósticas
Coyle reversa
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Imágenes diagnósticas
Coyle
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Imágenes diagnósticas
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Imágenes diagnósticas
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Imágenes diagnósticas
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Imágenes diagnósticas
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Imágenes diagnósticas
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Imágenes diagnósticas
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Clasificación
IIIIII
Regan – Morrey 1989
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Clasificación
Tipo I Tipo II Tipo III
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Clasificación
Clasificacion de O’Driscoll
Tipo Localización Subtipo Descripción
I Punta 1 < 2mm
2 > 2mm
II Antero medial
1 Borde anteromedial
2 Borde anteromedial + punta
3 Borde anteromedial + tub. Subllime + punta
III Basal 1 Coronoides y la base
2 Transolecraneana incluyendo base de la coronoides
O’Driscoll SW, Jupiter JB, Cohen MS, Ring D, McKee MD: Difficultelbow fractures: Pearls and pitfalls. Instr Course Lect 2003;52:113-134.
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Mecanismo…
Proceso coronoideo (punta): Valgo y supinación.
Anteromedial: Varo y rotación post-med. = evolución a artritis
Steinmann S P. Coronoid process fracture. J Am Acad Orthop Surg 2008;16:519- 529
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Tratamiento
Toda Fx con inestabilidad =
Cx
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Tratamiento
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Tratamiento
Beingessner DM, Stacpoole RA, Dunning CE, Johnson JA, King GJ:
The effect of suture fixation of type I coronoid fractures on the
kinematics and stability of the elbow with and without medial
collateral ligament repair. J Shoulder Elbow Surg 2007;16:213-217.
Hull JR, Owen JR, Fern SE,Wayne JS, Boardman ND III: Role of
the coronoid process in varus osteoarticular stability of the
elbow.
J Shoulder Elbow Surg 2005;14:441-446.
Closkey RF, Goode JR, Kirschenbaum D, Cody RP:
The role of the coronoid process in elbow stability: A
biomechanical analysis of axial loading. J
Bone Joint Surg Am 2000; 82:1749- 1753.
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Tratamiento
Fx de coronoides
No Fx cupula radial
(IRPMV)
Coronoides > 15%
Coronoides < 15%
Fx cupula radial
(IRPLV)Qx
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Tratamiento
> 15%
- Abordaje medial
- Placa ant-med o
tornillos- rep. LCL
< 15%
SubLx ulnohumera
l
NO
No Qx
SI
Reparacion LCLFijacion
coronoides
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Tratamiento
Tipo I
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Tratamiento
Tipo II
Varo
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Tratamiento
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Tratamiento
1: cápsula2: braquial3: coronoides4: LCM5: n. ulnar6: FCU
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Tratamiento
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Tratamiento
Tipo III
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Tratamiento
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Tratamiento
Sanchez-Sotelo J, MD, PhD, O’Driscoll S, MD, PhD, Morrey B, MD. Medial oblique compression fracture of the coronoid process of the ulna. J Shoulder Elbow Surg 2005;14:60-64.
Artrosis post-tx por Fx de tuberculo subllime
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Tratamiento
Julie E. Adams, M.D., Sheri M. Merten, R.N., and Scott P. Steinmann, M.D. Arthroscopic-Assisted Treatment of Coronoid Fractures. The Journal of Arthroscopic and Related Surgery, Vol 23, No 10 (October), 2007: pp 1060-1065
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Tratamiento
Julie E. Adams, M.D., Sheri M. Merten, R.N., and Scott P. Steinmann, M.D. Arthroscopic-Assisted Treatment of Coronoid Fractures. The Journal of Arthroscopic and Related Surgery, Vol 23, No 10 (October), 2007: pp 1060-1065
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Tratamiento
Julie E. Adams, M.D., Sheri M. Merten, R.N., and Scott P. Steinmann, M.D. Arthroscopic-Assisted Treatment of Coronoid Fractures. The Journal of Arthroscopic and Related Surgery, Vol 23, No 10 (October), 2007: pp 1060-1065
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Conclusiones...
Como lesión aislada es poco frecuente
Dx: Rx – TAC Clasificación O’Driscoll Evaluar estabilidad Tendencia Qx
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Gracias …