Term
| Supracondylar Extension Fractures |
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Definition
– Most Common Type
– Mechanism of injury
• Fall on outstretched arm with elbow in extension
– Imaging
• Distal humerus fractures and humeral fragment displaced posteriorly
• Sharp fracture fragments displaced anteriorly with potential for injury of brachial artery and median nerve
– Treatment
• Non-displaced fracture (Rare) = Immobilization in posterior splint – May be discharged home with close follow-up
• Displaced fracture
– Orthopedic Consultation and reduction
-Patients with displaced fractures or significant soft tissue swelling require admission for observation |
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Term
| Supracondylar Flexion Fractures(rare) |
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Definition
– Mechanism of Injury
• Direct blow to posterior aspect of flexed elbow
– Fractures are frequently open
– Imaging = Distal humerus fracture displaced anteriorly
– Treatment
• Non-displaced fractures
– Splint immobilization and early orthopedic follow-up
• Displaced fractures
– Orthopedic consultation for reduction
– Patients with displacement and soft tissue swelling require admission |
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Term
| supracondylar fraction complications |
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Definition
• Early Complications
– Neurologic (7%)
• Results from traction, direct trauma or nerve ischemia
• Radial Nerve (Posterior-medial displacement)
• MedianNerve(Posterior-lateral displacement)
• UlnarNerve(Uncommon)
• Anterior Interosseous Nerve Injuries – High incidence with supracondylar fractures – No sensory component, Motor component must be tested (“OK sign”)
– Vascular Entrapment(Brachial Artery)
• Late Complications
– Non-union/Mal-union
– Loss of mobility |
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Term
| Volkmann’s Ischemic Contracture |
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Definition
• Compartment syndrome of the forearm
• Complication of elbow/forearm fractures
• Increased compartment pressure results in ischemia of muscles of forearm, typically flexor compartment
• Patient complains of pain out of proportion of injury, digit swelling and paresthesias
• Also consider in any patient presenting with pain and numbness in hand after casting has been performed
• Irreversible damage in 6 hours (see image)
• Treatment
– Removal of cast
– Surgical decompression with fasciotomy
[image] |
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Term
|
Definition
• Most common fractures of the elbow
• Mechanism of Injury = Fall on outstretched hand
• Clinical Finding = Tenderness and swelling over the radial
head
• Imaging
– May not be seen on initial x-ray or may be subtle on x-ray
– Evaluate for anterior or posterior fat pad which suggests
diagnosis
• Associated Injuries
– Essex-Lopresti Lesion • Disruption of fibrocartilage of the wrist and interosseus membrane • Distal radial-ulnar dissociation
– Articular surface of capitellum frequently also injured
• Treatment
– Non-displaced = Sling, Ortho follow-up
– Comminuted/Displaced Fractures require urgent orthopedic
referral within 24 hours
[image] |
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Term
|
Definition
• Nursemaid’s elbow = Subluxation of radial head beneath the annular ligament
• Mechanism of injury = Longitudinal traction on hand or forearm with arm in pronation
• X-rays not necessary
• Treatment = Reduction
– Thumb over radial head with concurrent supination of forearm and flexion of elbow
– Extension and pronation (another option for reduction)
[image] |
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Term
|
Definition
• Third most common joint dislocation
• Posterolateral (90%)
– Mechanism of Injury=Fall on outstretched hand
– ClinicalFindings • Marked swelling with loss of landmarks • Posterior prominence of olecranon
– Immediate consideration must be given to neurovascular status • Ulnar or Median Nerve injury common (8-21%) • Brachial artery injury (5-13%)
– Associated fractures(30-60%) of coronoid process and radial head
– Terrible triad injury=elbow dislocation + radial head and coronoid
fracture (unstable)
• Anterior (Uncommon)
– Mechanism of Injury=Blow to Olecranon with elbow inflexion
– Associated Injuries= Much higher incidence of vascular impingement |
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Term
| Elbow Dislocation treatment |
|
Definition
• Elbow Reduction
– Immobilize humerus
– Apply traction at wrist
– Slight flexion of the elbow
– Posterior pressure on olecranon
• Post-Reduction
• Long Term Complications – Post-traumatic arthritis
– Joint instability |
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Term
| Both Bone Forearm Fracture |
|
Definition
• Fracture of both ulnar and radius – Usually displaced fracture
• Mechanism of Injury
– Direct blow to forearm
• Associated Injury
– Peripheral Nerve Deficits
• Uncommon in most closed injuries
• More common with open fractures – Development of compartment syndrome
• Treatment
– Displaced – ORIF
• Complications
– Compartment Syndrome – Malunion |
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Term
|
Definition
• Isolated fracture of ulnar shaft
• Mechanism
– Direct blow to ulna
– Patient raising forearm to protect face
• Treatment
– Non-displaced
• Immobilization in splint
– Displaced
• >10 degrees angulation
• Displacement > 50% of ulna
• Orthopedic consultation - ORIF
[image] |
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Term
|
Definition
• Distal Radius Fracture
– Distal radio-ulnar dislocation
• Reverse Monteggia’s fx
• Mechanism of Injury
– Direct blow to back of wrist – Fall on outstretched hand
• Complication = Ulnar nerve injury
• Treatment = ORIF
[image] |
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Term
|
Definition
• Proximal 1/3 Ulnar Fracture – Dislocation of radial head
• Mechanism of Injury = Direct blow to posterior aspect of ulna
– Fall on outstretched hand
• Imaging
– Elbow/Forearm x-rays
– Radial head dislocation missed in 25% of cases
– Carefully examine the alignment of radial head
• Associated Injury = Radial Nerve Injury
• Treatment – ORIF
– Closed Reduction/Splinting
[image] |
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Term
| Galeazzi vs. Monteggia Fractures |
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Definition
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Term
|
Definition
• Transverse fracture of distal radius with dorsal displacement of distal fragment
• Mechanism = Fall on outstretched hand
• Most common fracture in adults > 50 years old
• Exam = Classic Dinner Fork Deformity
• Associated Injuries
– Ulnar styloid fracture
– Median Nerve Injury
• Unstable Fractures
– >20 degrees angulation, intra-articular involvement, comminuted fractures or > 1 cm of shortening
Treatment
– Non-displaced Fracture
• Sugar Tong Splint, Referral to Orthopedic Surgery
– Displaced Fracture
• Reduction – Finger traps and manipulation under procedural sedation or with hematoma block
• Immobilization in Sugar tong splint
• Referral to Orthopedic Surgery |
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Term
|
Definition
• Transverse fracture of distal radius with volar displacement
• Mechanism = Fall on outstretched arm with forearm in supination
• Associated Injury = Median Nerve Injury
• Treatment
– Reduction with finger traps and manipulation – Immobilization in sugar tong or long arm splint – Orthopedic referral |
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Term
| colles fracture goals of reduction |
|
Definition
* Restore volar tilt
* Radial Inclination
* Proper radial length |
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Term
| radiographic evaluation of the elbow |
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Definition
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Term
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Definition
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Term
|
Definition
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Term
|
Definition
| colles fracture on left, smith on right |
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