Fracture neck of the radius
It occur due to fall on out stretched hands . In children usually it occur in the neck while in adult it occur in the head of the radius . Clinically : Pain and localized tenderness on the head of the radius and pain on rotating the forearm .treatment
Children up to 30` of radial head tilt and up to 3mm of transverse displacement is acceptable , and it treated by back slab with flexed elbow 90` . Displaced fracture more than this limit need manipulation under anesthesia , if failed then open reduction and fixation . Radial head should never excised in children , although it is one of the ways of the treatment of comminuted fracture of radial head in adult .Pulled elbow
In children the elbow may injured by pulling on the arm , it called subluxation of the radial head . It is really subluxation of the orbicular ligament which slip up over the radial head Clinically : The child is 2-3 years old is presented with painful elbow . The history is that the child being jerked by the arm and crying out in pain . On examination : the forearm is held in pronation and extension and resist any supination . X-ray : normal . Treatment : dramatic cure is achieved by forceful supination and then flexing the elbow .Pulled elbow
Reduction of annular ligament pulled elbowFracture capitulum
This is an articular fracture occur in adult . The patient fall on the hands with the elbow straight . The capitulum or the anterior part of it only is sheared off and displaced proximally . Clinically : Fullness in front of the elbow , flexion is completely restricted .x-ray :in lateral view the capitulum or part of it is seen in front of the lower part of the humerus . Treatment : Simple nondisplaced fracture treated by splintage for 2 weeks . Displaced fracture should be treated by open reduction and fixation .
Fracture capitulum
Fracture head of radiusIt is occur due to fall on out stretched hands with elbow extended ; it is common fracture in adult . It is of 3 types : 1- type one : vertical split in radial head . 2-type two : single fragment in the lateral portion is broken . 3- type three : comminuted fracture . Clinically : swelling at the elbow , marked tenderness at site , sever pain on pronation and supination .
Radial head fracture
Treatment : undisplaced fracture : type 1 treated by back slab above elbow for 3 weeks . Type 2 : if the piece is undisplaced then the treatment is like type one ; if the piece is big and displaced then it should be reduced and fixated by screw or wire . Type 3 treatment by excision of the head of the radius and some time replace it by prosthesis . Complication : 1- joint stiffness . 2- myositis ossificans .Fracture olecranon
2 types : 1- comminuted fracture . 2- transverse fracture . This fracture is due to direct blow while the triceps muscle is contracted . Clinically : in this fracture usually there will be bruises over the elbow and swelling ; some time we feel a gape in case of transverse fracture .Olecranon fracture and its fixation
Treatment : In case of comminuted fracture with triceps apponeorosis is intact , the treatment is by back slab for 3 weeks then simple active movement is encouraged to avoid stiffness ,if the fracture is transverse and undisplaced , the treatment will be by back slab the elbow is in flexion 60` for one week then full p.o.p. for another 3 weeks then exercise . For displaced transverse fracture it need internal fixation because it reduced only when the elbow is extended and stiffness of the elbow in that position is disastrous . The fixation is by tension band wire or by screws .Complication : Late : 1- stiffness of the elbow . 2- non union . It is occur after inadequate reduction and fixation of transverse fracture . It's treatment is by rigid fixation and bone grafting . 3- osteoarthritis of elbow joint , it occur if the reduction is inadequate .
Dislocation of the elbow
Dislocation of the ulno -humeral joint is common ; more so in adult than in children In 90% of cases the ulna is displaced posteriorly or postero -lateral . It is caused by fall on out stretched hand with the elbow in extension . If the dislocation is not associated with fracture the reduction of the dislocation will be stable and recurrent dislocation is unlikely.If the dislocation is associated with fracture or tear of the ligaments then the reduction will be unstable and recurrent dislocation is suspected . Anterior dislocation of the elbow can occur in ( side swipe) injury . Clinically : the patient support his or her forearm with the elbow in slight flexion .if the swelling is not so sever , the deformity is obvious . The relation of the olecranon to the epicondyles will be abnormal ; the examination is impossible due to sever pain , the hands examined for nerve and vascular injuries .
X-ray : it is done to confirm : 1- the presence of the dislocation . 2- the presence of the associated fracture . Treatment : Uncomplicated dislocation reduction should be done under G.A. with muscle relaxant ; the surgeon pull on forearm while the elbow is slightly flexed , the olecranon pushed by the thumb fore ward , then do gradual flexion of the elbow ; full flexion is can not be obtained unless perfect reduction done ; then checking of the 1- movement of the joint , it's full range . 2- it's stability . 3- distal neurovascular injuries .4- new x-ray to detect the reduction . Immobilization of the joint at 90` flexion in back slab for 1 week then full p.o.p. for 2-3 weeks .