elbow fractures and instabilities Flashcards
compare the locations of an extra-articular vs intra-articular distal humerus fracture
- extraarticular - supracondylar
- intraarticular - lateral or medial epicondyle, intercondylar, capitellum
what is the MOI of paediatric elbow fractures?
fall on outstretched hand
Describe a supracondylar fracture
-most common in children aged 5-10
-MOI= fall on hand with elbow extension
-MOI2 - direct anterior force against a flexed elbow
-very uncommon in adults
what are neurovascular complications from a supracondylar fracture?
-injury to the brachial artery
-compartment syndrome
-volkmanns ischaemic contracture (due to inadequate treatment of compartment syndrome0 - shortening of forearm flexors
-median nerve damage
what are other complications of supracondylar fractures other then neuromuscular?
-myositis ossificans - in brachialis region
-cubitus varus - malunion
what is the symptoms associated with a median nerve injury?
-ape hand
-hand of benediction
-tinel sign (tapping median nerve - imitates symptoms in hand)
describe an intracondylar fracture in children (lateral vs medial condyle)
-lateral condyle - common in children
-medial condyle - more common in early teens & males
describe a radial head and neck fracture in children
-1-5% of paediatric elbow fractures
-radial head subluxation can also occur
describe olecranon fractures in children
-uncommon
-can occur with radial head and neck fractures
how are displaced vs non displaced supracondylar fractures managed?
-non displaced - long arm splint and progress to cast w/ elbow at 90 deg flexion & forearm nuetral
-displaced - surgery to reduce and fix followed by splint or cast for 3-4 weeks
how are lateral condyle fractures managed?
splint / cast for 6 weeks
how are medial condyle fractures managed if they require surgery?
-shorter splint / cast time
-1-2 weeks
how many degrees displacement of the radial head requires surgery?
- more than 30
how are intercondylar fractures managed in adults?
-undisplaced or unicondylar fractures generally managed conservatively
-displaced or comminuted fractures can require surgery to fix
-difficult to fix as many bone fragments & loss of mineral density
-donjoy brace in flexion initially
what are examples of complications post interconydlar fracture in adults?
-elbow stiffness - asp loss of full extension
-early mobilisation generally recommended
-long term risk of OA if fracture extends into the elbow joint
-ulnar nerve palsy
what are some symptoms associated with ulnar nerve damage?
-muscle weakness in hand
-decreased grip strength
-muscle wasting - hypothenar eminence
-numbness, pain and tingling in hand
-clawing of 5th and 5th digits
what age groups most commonly suffer from a olecranon fracture?
-patient aged 50+
-if younger- high trauma injury
what are the causes of a fractured olecranon?
-direct - fall on point of elbow
-indirect - strong triceps contraction causing avulsion
how are hairline or undisplayed olecranon fractures managed?
-POP / donjoy cast in flexion
-early mobilisation in brace with avoidance of full flexion
how are displaced olecranon fractures managed?
- ORIF
what is the MOI for a dislocated elbow & which direction of dislocation is most common?
MOI= Fall with outstretched arm In extension
-posterolateral direction most common
if there is an anterior dislocation of the elbow, what can also be associated with it?
a fracture
how are dislocated elbows managed?
-reduce (correct misalignment)
-early mobilisations, work into extension
-collar and cuff
what are examples of complications post elbow dislocation?
-joint stiffness
-instability
-heterotrophic ossification (formation of mature lamellar bone in extra osseous tissue)
-recurent dislocation
-nerve damage eg medial - ulnar - but this is uncommon
