elbow fractures and dislocations
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ELBOW FRACTURES/ DISLOCATIONS
ELBOW FRACTURESDistal humeral fracturesCapitulum fracturesHead of radius fracturesRadial neck fracturesOlecranon process fracturesCoronoid process fractures
Distal humeral fractures
Ao – asif group classification Type A – an extra-articular supracondylar
fracture; Type B – an intra-articular unicondylar
fracture (one condyle sheared off); Type C – bicondylar fractures with
varying degrees ofcomminution.
Bryan and Morey classificationType I: Hahn-Steinthal fragment. Large
osseous component of capitellum, sometimes with trochlear involvement
Type II: Kocher-Lorenz fragment. Articular cartilage with minimal subchondral bone attached: “uncapping of the condyle”
Type III: Markedly comminuted
Head of radius fractures
Mason classification Type I An undisplaced vertical split in the
radial head Type II A displaced single fragment of the
head Type III The head broken into several
Radial neck fractures
A fall on the outstretched hand forces the elbow into valgus and pushes the radial head against the capitulum.
In children the bone fractures through the neck of the radius; in adults the injury is more likely to fracture the radial head.
Olecranon process fractures
Two broad types of injury are seen: (1) a comminuted fracture which is due to a direct blow
or a fall on the elbow(2) a transverse break, due to traction when the patient
falls onto the hand while the triceps muscle is contracted.
These two types can be further sub-classified into (a) Displaced (b) Undisplaced fractures. More severe injuries may be associated alsowith subluxation or dislocation of the ulno-humeraljoint.
Olecranon process fractures
Morrey Classification Type I: Undisplaced, stable fractures Type II: Displaced, stable Type III: Displaced, unstable fractures
Coronoid process fractures
Regan and Morrey classification Type I: Fracture avulsion just the tip of the
coronoidType II: Those that involve less than 50% of
coronoid either as single fracture or multiple fragments
Type III: Those involve >50% of coronoidSubdivided into those (A)without elbow dislocation(B)with elbow dislocation
Surgical treatment is given as appropriate
Plates and screws for comminuted fractures
Headless or lag screws for uncomminuted fractures
Collar and cuff for splinting or other splints in non surgical intervention.
Problems Stiffness of the elbow Loss of extension and flexion and
sometimes pronation and supination Pain Myositis ossificans Vascular insufficiency Nerve damage (ulnar and median nerve) Mul union
Problems Delayed union Non union Elbow instability Muscle spasm Muscle weakness Muscle atrophy Joint deformity Bone infection (osteomyelitis) Osteoporosis loss of bone density as a result of reduced
functionality Thrombus formation
Ultrasound to loosen adhesions/ myositis ossificans
Massage (hacking) and muscle stretch to realese contractures
Range of motion exercizes to increase extension, flexion, supination and pronation.
Tens/ift for pain medication and muscle spasm.
Circulatory exercizes for vascular insufficiency
Nerve glides for nerve damage if neuropraxic
Nerve stretching Immobilisation in cast in cases of mal
union, delayed union and non union then refere for re assesment.
Immobilising in armsling for elbow instability. Untill healing takes place.
Muscle strengthening exercizes for muscle weakness, muscle atrophy and immobility osteoporosis.
Order for a check x-ray if there is joint deformity for appropriate progression of therapy.
with chronic uhealing wounds discharging pus suspect osteomyelitis, and recommend biopsy for microbiology examination.
tubi grip will be appropriate for dvt (paget von schruetter disease).
Posterior/ posterolateral Forward dislocation (side swipe) Lateral Anterior
General• The most common type of dislocation in
children and the second most common type in
adults, second only to shoulder dislocation• Young adults between the ages of 25–30
years are most affected and sports activities
account for almost 50% of these injuries• Mechanism: Fall on the outstretched hand
Clinical• Dislocation can be anterior or posterior
with posterior being the most common, occurring
98% of the time.• Associated injuries include fracture of
the radial head, injury to the brachial artery and median nerve
Isolated dislocation of radial head A true isolated dislocation of the radial head is
very rare; if it is seen, search carefully for an associated fracture of the ulna (the Monteggia fracture).
In a child, the ulnar fracture may be difficult to detect if it is incomplete, either green-stick or plastic deformation of the shaft;
it is very important to identify these incomplete fractures because even a minor deformity, if it is allowed to persist, may prevent full reduction ofthe radial head dislocation.
Symptoms• Inability to bend the elbow following a
fall on the outstretched hand• Pain in the shoulder and wrist• On physical exam: The most important
part of the exam is the neurovascular evaluation of
the radial artery, and median, ulnar and radial nerves
Imaging• Plain AP and lateral radiographs• CT and MRI scans are seldom necessary
Treatment• Reduce dislocation as soon as possible
after injury• Splint for 10 days• Initiate ROM exercises, NSAIDs
Complications • Loss of ROM of elbow especially
extension• Ectopic bone formation• Neurovascular injury• Arthritis of the elbow
Apley orthopaedic textbook Upper limb fractures Physical medicine and rahabilitation