Injuries around elbow
Anatomy of elbow jointSurface anatomy of elbow
Elbow dislocation is a Common injury, 90% of dislocations are posterior or posterolateralnote: the imaginary line which pass through the axis of the radius should pass through the capitulum in all views, if it doesn’t pass, the radial head is dislocated.Elbow dislocation
MechanismFall on outstretched hand usually Produce isolated dislocation.
Sideswipe injury: when the drivers elbow projected from the care and strikes by another care ; usually associated with other fracture around elbow
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Clinical features
Swelling Deformity Loss of 3point configuration of elbowTreatment
Simple dislocation: reduction under general anesthesia. Longitudinal traction , thump pressure over the olecranon , correct the sideway tilt, backslap for 3 week then physiotherapy. Dislocation with fracture ( olecranon, medial epicondyle, coronoid process) the fracture must be fixed internally after reduction of dislocation.
Radial head fracture
Mechanism: fall on outstretched hand with elbow pronatedMason classification
Type-I: Undisplaced vertical split Type-II: displaced single fragment Type-III: comminuted radial head fractureI
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Management
Type-I: aspirate hematoma, inject local anesthesia, collar and cuff for 3 weeks, then physiotherapyType-II : reduction of the fragment and fixation by Herbert screw
Type-III: look for associated injuries like Fracture coronoid process Rupture of interosseous membrane (Essex lopresti injury)
If these injuries is present the treatment is either reconstruction of the head with internal fixation or replacement with a metal spacer
If no any of associated injuries is present : excision of radial head done. Radial head excision is contraindicated in children before closure of epiphysis and in adult if any associated injuries.
Terrible triad of elbow
It is a combination of Radial head fracture Coronoid fracture Elbow dislocationTreatment by open reduction And internal fixation
Fracture olecranon
It is of 2 types: Transvers fracture 2. Comminuted fracture. Each on of these types subdivided to displaced or non displacedMechanism of injury: 1.direct trauma by fall on the point of elbow. Usually lead to comminuted fracture
2. Indirect trauma by falling with forceful contraction of triceps muscle, usually lead to transvers fracture
Treatment: Undisplaced fracture treated by arm sling for 3 weeks followed by physiotherapy. Displaced transvers fracture treaded by ORIF by screw and tension band wire
Displaced comminuted fracture treated by fixation with plate and screw with bone graft
Fracture lateral condyle in childrenMechanism of injury: fall on outstretched hand with elbow extended.
Milch classification type-I : fracture lateral to the trochlea and the joint is not involved and the joint is stable. type-II: the fracture pass through the trochlea and the joint is unstable.
Clinical features: Pain Bruises over the lateral side of the elbow Deformity Passive flexion of the wrist may cause pain
Treatment: Undisplaced fracture: backslap with elbow flexed 90 degree and wrist extended for 2 weeks. Displaced fracture: open reduction and internal fixation by k-wires
Non union of lateral condyle of elbow in children considered serious complication because it may lead to cubitus valgus deformity and delayed ulnar nerve palsy , that is why lateral condyle fracture in children is fracture of necessity
Pulled elbow ( subluxation of radial head)
It is subluxation of annular ligament from the head of the radius into radiocapital jointClinical feature: Pain and crying child of 2-3 years history of the arm being jerked The forearm locked in pronation
Treatment Dramatic response is achieved by forceful supination and extension of the forearm with palpable snapping