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Ortho > Chapter 30- Fractures of the humerus and elbow > Flashcards

Chapter 30- Fractures of the humerus and elbow Flashcards

1
Q

What are the two necks of the humerus called and where are fractures more likely seen?

A
  • Anatomical neck: edge of the articular surface or old physeal scar
  • Surgical neck: demarcation of the tuberosities from the shaft
  • Fractures more commonly seen through the surgical neck
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2
Q

What type of fractures are seen at the head/ articular surface of the humerus?

A
  • Head splitting or impression fractures

- Fractures through the anatomical neck causing articular surface detachment (risk of avascular necrosis)

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3
Q

Fracture of the greater and lesser tuberosities is often associated with which other injury

A

-Shoulder dislocation

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4
Q

Fractures of the proximal humerus are seen in young people with good bone stock or old people with osteoporotic bone, what is the typical history/ presentation in each group?

A
  • Young people: high energy injury, other associated injuries or multiple fractures. Often present with complex fractures of the proximal humerus involving more than one anatomical segment
  • Old people: low energy injuries (simple fall). Fractures are relative stable.
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5
Q

What are the examination findings in patients with fractures of the proximal humerus

A
  • Marked local swelling and bruising in the high energy injuries
  • marked bruising, often down the length of the inner aspect of the upper arm, in low energy injuries
  • Inability to move the arm
  • 5% will have clinical nerve injuries
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6
Q

Which three Xray views should be requested in a proximal humerus fracture?

A
  • AP
  • Lateral scapula
  • Modified axillary views
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7
Q

In elderly patients, what is the cause of the apparent inferior subluxation of the humeral head in proximal humeral fractures?

A

Inhibition of the rotator cuff by pain which allows the head to sag

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8
Q

Treatment of undisplaced fractures of the proximal humeral head

A
  • Shoulder immobilizer or a body bandage and collar and cuff
  • Followed with weekly Xrays
  • Analgesia and sleeping tablets
  • usually start gentle pendulum and range of motion at three weeks
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9
Q

What is the definition of a displaced fracture of the head of the humerus?

A
  • More than 1 cm displacement or 45 degrees of angulation between the fragments
  • For younger patients it is now thought to be 0.5 cm and 30 degrees
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10
Q

Treatment of fracture of the head/articular surface of the humerus?

A
  • Young patient: Open reduction and internal fixation
  • Old patient: hemi-Arthroplasty to replace the humeral head. If patient not fit for surgery then shoulder placed in immobiliser until pain is settled and then gentle active movement commenced
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11
Q

Treatment of displaced fracture of the humeral tuberosities?

A

-Surgically reduced and fixed

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12
Q

When should a fracture of the surgical neck of the humerus have open reduction and internal fixation?

A

If irreducible or if associated with a fracture of the head and or tuberosities

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13
Q

Where does the radial nerve run (in relation to the humerus)

A

The radial nerve winds its way around the shaft of the humerus. It lies in close contact to the posterior aspect of the mid-shaft of the humerus (In the spiral groove)

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14
Q

What is the typical history in a fracture of the shaft of the humerus?

A
  • Direct force: motor vehicle, gunshot, direct blow to arm

- Indirect force: Twisting arm while falling on hand, forced external rotation

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15
Q

What are the examination findings in a fracture of the shaft of the humerus?

A
  • Painful, swollen upper arm
  • Inability to lift the arm
  • Always check for radial nerve function
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16
Q

Which plaster techniques can be used to treat humeral shaft fractures

A

-Hanging casts
-U- Slabs
Use the same philosophy of using gravity to align the fracture

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17
Q

What are the surgical means of immobilization of a humeral shaft fracture?

A

Plating, nailing and external fixation

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18
Q

When is surgical immobilisation done in a humeral shaft fracture?

A
  • Polytrauma
  • Patients who will be recumbent
  • Severe chest trauma
  • Open fractures
  • Brachial plexus or nerve injury
  • Concomitant injury of the shoulder, elbow or forearm
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19
Q

which groups of people usually suffer from supracondylar fractures?

A

Children and old people suffering from osteoporosis

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20
Q

What is the typical fracture pattern when young people suffer from supracondylar fractures?

A

-Additional vertical split between the condyles(T or Y intercondylar fractures)

21
Q

Typical history of a supracondylar or intercondylar fracture

A
  • Low energy fall on outstretched hand

- high energy vehicular or gunshot injury

22
Q

Examination findings of supracondylar or intercondylar fracture?

A
  • marked swelling, bruising around elbow region
  • Inability to move the elbow joint
  • Must exclude and avoid a compartment syndrome
23
Q

What investigations should be done in a supracondylar or intercondylar fracture

A
  • AP and lateral xrays to demonstrate fractures
  • Oblique or traction views to plan surgery
  • CT scans when the fracture cannot be adequately visualised
24
Q

Treatment of supracondylar or intercondylar fracture

A

-Adults: open reduction and internal fixation
If not possible, manipulated and treated in a shoulder immobiliser (Bag of Bones technique); or modified Dunlop traction
-Total elbow replacements for non-reconstructable fractures

25
Q

Typical history of a condylar fracture

A

Fall on the arm with a varus or valgus force

26
Q

Findings on examination of a condylar fracture

A
  • pain, tenderness and fullness anterior to the elbow joint

- reduced range of movement of the elbow joint

27
Q

Treatment of condylar fractures

A
  • undisplaced: Backslab for 4-6 weeks

- Displaced- Open reduction and internal fixation

28
Q

What injury is Medial epicondyle avulsion usually associated with?

A

Elbow dislocation

29
Q

Typical history of epicondylar fractures

A
  • Forcible muscle contraction of the forearm, or excessive varus/ valgus stress
  • pain over the epicondyle, and on contraction of the forearm muscles
30
Q

Findings on examination of epicondylar fractures

A
  • Tenderness, swelling and bruising over the medial and lateral epicondyle
  • Weakness of the forearm flexors and extensors
  • Decreased range of elbow movement if the epicondyle is trapped in the joint
31
Q

Treatment of epicondylar fractures

A

-Displacement of > 5mm: Open reduction and fixation

32
Q

What is the most common direction of elbow dislocation

A

-Posterior dislocation, forearm bones displacing posterior to the humerus, often accompanied with either lateral or medial displacement

33
Q

What is divergent dislocation of the elbow

A

Forearm bones part company with one anterior and one posterior to the humerus OR one medial and one lateral to it.

34
Q

What is the important implication of a divergent dislocation?

A

The interosseus membrane has been torn as a result of the distal humerus being driven forcibly between the radius and ulna- high likelihood of neurovascular involvement

35
Q

what three joints make up the ‘elbow joint’

A

-Ulna humeral
Radio humeral
Proximal radio-ulnar

36
Q

Typical history of dislocation of elbow joint

A
  • Fall on semi-extended arm, will push forearm posteriorly

- Patient will complain of pain over the elbow joint and inability to flex/ extend the elbow

37
Q

Examination findings in dislocation of elbow joint

A
  • obvious deformity around the elbow region, forearm appearing shortened
  • Distortion of the normal bony landmarks around the elbow
  • Limitation of all movement at the elbow joint
  • Neurovascular examination is essential
38
Q

Treatment of elbow dislocations

A
  • Reduction under anaesthesia
  • Medial or lateral displacement corrected and then traction applied in semi-flexed position until clunk heard and allows full passive extension and flexion
  • Post reduction Xray
  • Backslab for 10 days –> gradual range of motion in shoulder immobilizer
  • 2 weeks of indocid to prevent heterotopic ossification
39
Q

What are the two basic functions of the olecranon

A
  • Insertion of triceps tendon

- Articulates with trochlea of humerus

40
Q

Typical history of olecranon fracture

A
  • Direct blow to the elbow
  • Penetrating injuries of the elbow
  • Fall on hand with triceps contracted
  • Patient complains of pain and swelling over the area, and an inability to actively extend the elbow
41
Q

Findings on examination of olecranon fracture

A
  • Tenderness and swelling over the tip of the olecranon and the proximal ulna
  • Loss or limitation of active elbow extension
  • Gap may be palpable over the fracture site
42
Q

Treatment of olecranon fracture

A

Open reduction and internal fixation with tension band wiring tecnique or a plate is the method of choice

43
Q

Typical history of fractures of the radial head

A

fall on the outstretched hand with a valgus force

44
Q

Findings on examination of a fracture of the radial head

A
  • swelling around the elbow
  • pain and tenderness over the radial head
  • Flexion/ extension of the elbow is painful but possible
  • pain exacerbated by pronation and supination of the forearm which are severely limited
45
Q

What xray views should be requested in fracture of the radial head

A

Oblique/ radial head views

46
Q

When can a fracture of the radial head be treated conservatively with splinting and analgesia?

A

Rule of threes:

If the fracture involves less than 1/3 of the head, 30 degrees of tilt or 3 mm of displacement

47
Q

What are the surgical options for fracture of the radial head

A

Internal fixation- use of mini fragment screws

Excision of the head/ radial head replacement

48
Q

When should excison of the radial head be done in a fracture of the radial head?

A

Severely comminuted fractures which cannot be reconstructed for fixation and there is no elbow dislocation nor associated forearm/ wrist injury

49
Q

Treatment of fractures of the radial neck

A
  • Minimal angulation of the head in adults can be accepted and treated conservatively
  • Angulation of >30 degrees should be corrected- usually surgically, and the head fixed to the neck with either small screw/ plate

Ortho (41 decks)

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