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    Fractures of The Elbow Joint 2

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    Noor Al Zahraa Ali
    1. Fractures of the elbow joint can occur in children and adults through direct or indirect trauma. Common fractures in children include supracondylar fractures, lateral condyle fractures, and fractures of the neck of the radius. 2. Treatment depends on the type and degree of displacement of the fracture. Undisplaced fractures are usually treated with splinting while displaced fractures often require closed or open reduction and internal fixation. 3. Complications can include malunion, stiffness, nerve injuries, and failure of the fracture to unite properly. Close follow up is important to monitor for these potential issues.

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    Fractures of The Elbow Joint 2

    Uploaded by

    Noor Al Zahraa Ali
    21 views41 pages
    1. Fractures of the elbow joint can occur in children and adults through direct or indirect trauma. Common fractures in children include supracondylar fractures, lateral condyle fractures, and fractures of the neck of the radius. 2. Treatment depends on the type and degree of displacement of the fracture. Undisplaced fractures are usually treated with splinting while displaced fractures often require closed or open reduction and internal fixation. 3. Complications can include malunion, stiffness, nerve injuries, and failure of the fracture to unite properly. Close follow up is important to monitor for these potential issues.

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    Fractures of the Elbow Joint 2 (1)

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    1. Fractures of the elbow joint can occur in children and adults through direct or indirect trauma. Common fractures in children include supracondylar fractures, lateral condyle fractures, and fractures of the neck of the radius. 2. Treatment depends on the type and degree of displacement of the fracture. Undisplaced fractures are usually treated with splinting while displaced fractures often require closed or open reduction and internal fixation. 3. Complications can include malunion, stiffness, nerve injuries, and failure of the fracture to unite properly. Close follow up is important to monitor for these potential issues.

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    21 views41 pages

    Fractures of The Elbow Joint 2

    Uploaded by

    Noor Al Zahraa Ali
    1. Fractures of the elbow joint can occur in children and adults through direct or indirect trauma. Common fractures in children include supracondylar fractures, lateral condyle fractures, and fractures of the neck of the radius. 2. Treatment depends on the type and degree of displacement of the fracture. Undisplaced fractures are usually treated with splinting while displaced fractures often require closed or open reduction and internal fixation. 3. Complications can include malunion, stiffness, nerve injuries, and failure of the fracture to unite properly. Close follow up is important to monitor for these potential issues.

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    Fractures of the Elbow Joint

    Dr,Ghadeir Hikmet
    Anatomy
    Elbow joint is a hinge joint that allows the
    following movements :Flexion, Extension ,
    Pronation & Supination .The normal carrying
    .angle in extension is 15-20 valgus
    The medial ,Lateral condyle & olecranon are in
    one line in extension & in flexion they form a
    .triangle of equal length
    Time of appearance of Ossifying centres around the
    :elbow joint is roughly as follows
    CRITOE” from 2-12 years“
    .Capitellum: At the 2nd year of life
    Radial head :At the 4th year of life
    Internal Condyle : At the 6th tear of life
    Trochlea : At the 8th year of life
    Olecranon : At the 10th year of life
    External Condyle : At the 12th year of life
    :Mechanism
    Either Direct or Indirect by a fall on an
    .outstretched hand either in varus or valgus
    Supracondylar fractures
    ”“In Children
    :Types
    Extension (Posterior) Type : Occurs in 95% because of )1
    .displacement of the distal piece backwards
    Flexion (Anterior) Type :Occurs in 5% because the distal )2
    .piece displaces forwards

    In extension type ,in addition to the backward displacement


    of the distal piece & because of pronation , the distal piece
    will rotate inwards .The proximal piece by it’s jagging end
    .will injure the brachial artery or the median nerve
    Classificatin by Wilkins
    .Type I : Undisplaced
    .Type II : Displaced with intact posterior cortex
    .A): With mild rotation & Angulation
    .B):With Moderate rotation & Angulation
    Type III : Total loss of continuity of posterior
    .cortex
    Clinical features
    Pain ,Swelling , Deformity , Tenderness & Loss of -
    .function
    .We always check for peripheral pulses & nerve injury -
    X-ray : AP is difficult to obtain it because of pain. -
    .Lateral is easy & likely to assess the injury
    Baumanns Angle: Axis through long axis of shaft of
    Humerus crossed by a line through the coronal axis
    of the capitellar physis. If the angle is more than 80 ,
    .the arm has a varus deformity
    Treatment
    Type I: back slab while the elbow is flexed 90 & Neutral )1
    rotation for 3 weeks. It is followed by regular check up
    .weekly

    Type II(A): MUA by traction for 2-3 minutes in extension )2


    against counter pressure, with correction of sideway tilt
    or rotation then gradual flexion of elbow with pronation
    to 120 with finger on the pulse , If it disappears, We
    extend the elbow until the pulse returns .Back slab is put
    .for 3-4 weeks with regular check x-ray weekly
    :Type II(B) & Type III )3
    .ORIF by K wires
    :Anterior Type )4
    Anterior pressure over the distal segment with
    correction of deformity & We put back slab in
    extension for 3 weeks with regular check x-ray
    .weekly
    Complications
    :Early
    .Vascular Injury in 1-5%-
    .Nerve Injury-
    :Late
    .Malunion especially cubitus varus-
    .Stiffness of elbow-
    .Myossitis ossificans-
    Fracture Lateral Condyle
    Age: In children, it is an epiphyseal avulsion
    .injury by common extensor group of muscles
    .In adults it is a fracture

    Mechanism : Fall on outstretched hand in


    .extension & Varus
    Clinical features
    Pain , Swelling , Tenderness , Deformity & Loss-
    .of function
    X-ray : It is misleading because the piece is-
    mainly cartilaginous so it appears smaller than
    .it’s actual size
    :This fracture is important because-
    .It damages the growth plate )1
    .It is intraarticular )2
    :Note
    We take AP & lateral X-ray views: The fracture
    line is oblique, if it passes lateral to the
    trochlea it is stable , if it passes through the
    trochlea , it is unstable
    Treatment
    Undisplaced: Back slab with the elbow flexed &-
    .wrist extended for 3 weeks
    Displaced (Gap more than 2mm): Needs ORIF-
    .by K wires and back slab for 3 weeks

    :Complications
    Malunion , Non Union , Stiffness of elbow &
    .Recurrent dislocation
    Fractured Medial Condyle
    .Rare Intra articular fracture
    :Mechanism
    Direct by a blow on the elbow or indirect by a fall on
    .outstretched hand in extension & Valgus

    The fracture line passes through the physis & exit


    through the trochlea notch or laterally & the piece is
    pulled by the common flexor group. Because it is
    cartilaginous, it will appeared on x-ray smaller than it’s
    .actual size
    :Clinical features
    .Pain , Swelling , Tenderness , Deformity , Los of function

    .X-ray: Ap/Lateral views

    :Treatment
    undisplaced : Slab for 2-3 weeks with regular check x-
    .ray
    .Displaced: ORIF-
    :Complications
    .Ulnar nerve damage & Stiffness of elbow
    Separation of Medial epicondyle Apophysis

    Mechanism: A fall on outstretched hand in


    extension & valgus leading to avulsion by
    common flexor group with various degrees of
    displacement from humerus & when there is
    transient open-up of the joint space, the piece
    .gets capsized in the joint
    :Clinical features
    Pain , Swelling , Tenderness , Deformity ,Loss of
    .function

    .X-ray:AP/Lateral views

    :Treatment
    .Undisplaced : Back slab 2-3 weeks-
    .Displaced: Operative fixation-
    Fracture Neck of Radius
    ”“In Children
    :Mechanism
    .Fall on outstretched hand with valgus

    :Clinical features
    Pain , Swelling , Tenderness , Deformity & loss of
    .function

    X-ray : Ap/lateral views : The fracture line transverse


    .with or without triangular fragment of metaphysis
    :Treatment
    Up to 30 angulation or 3 mm displacement-
    .treated by arm sling for 2-3 weeks
    if there’s more displacement, We do MUA with-
    the elbow extended & in varus We thumb the
    .piece back
    if failed We do Open Reduction and once the-
    piece is reduced ,there is no need for internal
    .fixation
    Fractured Capitellum
    .This is an Intra articular fracture occurs in adults
    Mechanism: Fall on outstretched hand ,a piece is
    .sheared off & is displaced proximally

    :Clinical features
    Pain, Swelling , Tenderness, Deformity & loss of
    .Function
    X-ray : Ap/Lateral views : Displaced or Undisplaced
    .fracture
    :Treatment
    .Undisplaced : back slab for 3 weeks)1
    .Displaced : ORIF)2
    For neglected cases: excision of capitellum)3
    .especially in middle aged or elderly
    Fracture of Head Radius
    ”“Adults
    Mechanism : Fall on Outstretched hand with
    .pronation
    :Types
    Type I: Vertical split
    Type II: Single fragment of lateral part of head
    .displaced distally
    .Type III: Comminuted
    :Clinical features
    Pain , Swelling , Tenderness , Deformity & Loss of
    .Function

    .X-ray:AP/lateral views
    Treatment
    .Type I: Arm sling with gradual active movement
    .Type II: ORIF by screws
    .Type III: Excision

    :Complications
    Joint stiffness , Myositis Ossificans , Recurrent
    .elbow dislocation
    Fractured olecranon
    .It occurs in children and adults

    :Mechanism
    Direct trauma: Leads to comminution but with-
    .intact extensor mechanism
    Indirect trauma: Avulsion injury leads to a-
    transverse fracture with separation of the
    .piece with loss of extensor mechanism
    :Clinical Features
    Pain Swelling , Tenderness , Deformity & Loss of
    .function

    X-ray: Ap/Lateral views


    Treatment
    Comminuted fractures: Treated conservatively by )1
    .back slab for 2-3 weeks
    Undisplaced fracture: Backslab in 60 flexion for 2-3)2
    .weeks
    .Displaced fracture :ORIF)3

    :Complications
    Elbow stiffness , non Union , articular damage with
    .late Osteoarthritis
    Fracture Separation of Distal Humeral Physis

    Up to age of 7, the distal humerus epiphysis is a


    solid cartilage segment that might with severe
    .trauma displace laterally

    :Clinical features
    .Pain , Swelling , Tenderness & Deformity

    .X-ray :AP/Lateral views


    Treatment
    As a case of Supracondylar fracture. If the
    diagnosis is uncertain , the elbow is splinted in
    .flexion for 2 weeks
    Pulled Elbow
    .Age : Young Children
    Mechanism : Pulling the forearm in pronation
    leading to subluxation of orbicular ligament
    .over the head of radius

    : Clinical features
    Pain , Swelling , forearm laid extended &
    .pronated
    .X-ray : usually normal

    : Treatment
    Supination then flexion of the elbow , the
    ligament slips back with snap , then put an
    .arm sling
    Fractureof distal Humerus
    ”“Adults
    .Type A : Supracondylar (Extraarticular)
    Type B : Intraarticular Unicondylar (One condye
    is sheared off & the other still in continuity
    .with the humeral shaft)
    Type C : Bicondylar fracture with varying degrees
    .of comminution
    Type A is rare , usually displaced , unstable
    ,caused by high energy trauma . Unlike the
    supracondylar fractures in children , theres no
    tough periosteum to tether the fragment.
    There’s pain , Swelling , Tenderness &
    .Deformity
    .X-ray :AP/Lateral views
    .Treatment : Usually operative by ORIF
    Type B & C : These are intraarticular injuries caused
    by high energy trauma with soft tissue damage .
    .They are caused by direct trauma

    : Mechanism
    The Olecranon is displaced upwards splitting the
    condyle apart & the bony landmark around the
    elbow is distorted. The patient must be
    .examined always for neurovascular injury
    X-ray : AP/Lateral views will show one of the
    :following
    Either Undisplaced fracture or fracture extend-
    into the metaphysis in a T or Y shape with
    .various degrees of displacement
    Or it shows severe comminution (according to-
    severity of trauma)
    Treatment : There is usually displaced intra
    .articular injury & best treated by ORIF
    Dislocation of Elbow Joint
    Dislocation of Humero-Ulnar joint is common &
    more in adults than in children. It is classified
    .according to the directions of displacement
    are posterior or posterolateral with or 90%
    without fracture of the remaining bony
    .prominence
    Mechanism : Fall on outstretched hand in
    extension with associated soft tissue injury with
    .or without neurovascular injury
    :Clinical features
    .Pain , Swelling , deformity & Loss of function

    X-ray : AP/Lateral views to confirm diagnosis & if there is


    associated fracture of medial epicondyle or head f Radius or
    .Olecranon

    Treatment : MUA & slab for 2-3 weeks with check x-ray after
    .reduction
    If there is associated fracture or soft tissue interposition , We do
    .ORIF of the fracture
    :Complications
    :Early-
    .Vascular : Brachial artery injury)1
    .Nerve Injury : Median nerve)2

    :Late-
    Stiffness , Unreduced dislocation , Heterotopic
    .ossifications

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