Y5 - Elbow: fracture (coronoid, olecranon, radial head)

Question 1

what are coronoid fractures indicative of

Answer 1

an episode of elbow instabiltiy

Question 2

what can coronoid fractures be associated with

Answer 2

elbow dislocation

Question 3

what is the mechanism for how a coronoid fracture occurs

Answer 3

a traumatic shear injury

- the distal humerus is driven against the coronoid with an episode varus stress or posterior subluxation

Question 4

is a coronoid fracture an avulsion fracture

Answer 4

no

Question 5

why can a coronoid fracture amplify elbow instability

Answer 5

the anterior bundle of the medial collateral ligament attaches to the sublime tubercle distal to the tip
and the anterior capsule attaches distal to the tip of the coronoid

Question 6

what is the terrible triad of elbow fracture dislocation

Answer 6

an elbow dislocation associated with radial head fracture and coronoid fracture

Question 7

epi

Answer 7

10% of elbow injuries

Question 8

what is posteromedial rotatory instability

Answer 8

coronoid anteromedial facet fracture, LCL injury

Question 9

what is posterolateral rotatory instability

Answer 9

coronoid tip fracture, radial head fracture, LCL injury

Question 10

what is olecranon fracture-dislocation associated withq

Answer 10

a large coronoid fracture

Question 11

what is the medial facet of the coronoid important for

Answer 11

varus stability

Question 12

what does the medial facet of the coronoid do

Answer 12

provides insertion for the medial ulnar collateral ligament

Question 13

what is the coronoid important for

Answer 13

preventing posterior subluxation

Question 14

what classification is used for coronoid fractures

Answer 14

regan and morrey classification

Question 15

what are the three types of regan and morrey classification

Answer 15

type 1 coronoid process tip fracture
type 2 fracture of 50% or less
type 3 fracture of 50% or more

Question 16

presentation of coronoid fracture

Answer 16

elbow deformity, pain, swelling

Question 17

physical exam of a coronoid fracture

Answer 17

varus or valgus deformity
ecchymosis & swelling
tenderness
crepitus

Question 18

investigations

Answer 18

Xray

Question 19

what view on a xray would be useful for elbow fractures

Answer 19

AP and lateral elbow

Question 20

management for non-operative fractures

Answer 20

period of immobilisation

followed by reintroduction into range of motion

Question 21

what are the indications for non-operative fractures

Answer 21

all types of the regan and morrey classification with a minimally displaced stable elbow

Question 22

what are the different types of olecranon fracture

Answer 22

1 isolated undisplaced/stable fracture

2 displaced/unstable fracture

Question 23

management for an isolated undisplaced or stable olecranon fracture

Answer 23

immobilisation at above-elbow at 90 degrees elbow flexion

Question 24

management for a displaced or unstable olecranon fracture

Answer 24

place arm in above-elbow backslab at 90 degrees elbow flexion and refer to ortho

Question 25

what do most displaced or unstable olecranon fractures require

Answer 25

reduction/fixation

Question 26

how are olecranon fractures classified

Answer 26

anatomical location fracture pattern displacement

Question 27

what different anatomical locations are common in olecranon fractures

Answer 27

metaphyseal physeal epiphyseal

Question 28

what are the different fracture patterns for olecranon fractures

Answer 28

transverse oblique longitudinal

Question 29

when is deformity associated with olecranon fracture

Answer 29

with radial head dislocation

Question 30

what investigations are ordered for potential olecranon fracture

Answer 30

AP and lateral view of the elbow

Question 31

what must the AP view of the elbow in a potential olecranon fracture show

Answer 31

the relationship of the proximal radius and the ulna to the humerus

Question 32

what % of olecranon fractures require reduction

Answer 32

20%

Question 33

what is the olecranon part of

Answer 33

the ulna

Question 34

when may an olecranon fracture occur

Answer 34

a fall onto the outstretched arm | intense contraction of the triceps tendon

Question 35

what is the mayo classification of olecranon fractures based upon

Answer 35

the stability, the displacement, and the comminution of the fracture

Question 36

what are the different types of olecranon fracture for the mayo classification

Answer 36

T1 non-displaced fracture T2 displaced stable fracture T3 displaced unstable fracture

Question 37

what is a T2 displaced stable fracture

Answer 37

fracture fragment is displaced more than 3mm but ligaments are intact

Question 38

what is a T3 displaced unstable fracture

Answer 38

displaced fracture fragment with damaged ligaments

Question 39

what are the different subtypes of mayo olecranon fractures

Answer 39

non-comminuted | comminuted (lots of fragements)

Question 40

who are olecranon fractures common in

Answer 40

adults due to its exposed position | rare in children

Question 41

what nerve may be damaged with an olecranon fracture

Answer 41

olecranon forms part of the ulna, therefore may cause ulnar injury (numbness and tingling in the 4th and 5th fingers)

Question 42

management for nondisplaced olecranon fracture

Answer 42

immobilisation with a posterior splint with limited flexion

Question 43

management for a displaced olecranon fracture

Answer 43

surgically | e.g. tension band fixation

Question 44

what is the most common cause of a radial head fracture

Answer 44

an outstretched arm

Question 45

management of a radial head fracture

Answer 45

nondisplaced/stable is supportive casting | displaced/unstable is possible surgery

Question 46

epidemiology of radial head fractures

Answer 46

women>men | 30-40yrs

Question 47

what are the most common elbow fractures

Answer 47

radial head fractures

Question 48

what is the mechanism of injury of a radial head fracture

Answer 48

fall onto an outstretched arm | elbow extension and forearm pronation

Question 49

what injuries are associated with a radial head fracture

Answer 49

``` ligament injury (lateral collateral ligament) Essex-Lopresti injury ```

Question 50

what is a essex-lopresti injury

Answer 50

a distal radioulnar joint injury

Question 51

what classification system is used for radial head fractures

Answer 51

mason classification

Question 52

what are the 4 different types of mason classification for radial head fractures

Answer 52

type I - nondisplaced or minimally displaced type 2 displaced >2mm type 3 comminuted and displaced type 4 radial head fracture

Question 53

what does the lateral pivot shift test

Answer 53

lateral ulnar colateral ligament

Question 54

what does the valgus stress test

Answer 54

medial collateral ligament