Elbow fractures and dislocations

ELBOW FRACTURES/
DISLOCATIONS
TRINITY ANGONI

ELBOW FRACTURESDistal humeral fractures
Capitulum fractures
Head of radius fractures
Radial neck fractures
Olecranon process
fractures
Coronoid process
fractures

Distal humeral fractures
Ao – asif group classification
 Type A – an extra-articular supracondylar
fracture;
 Type B – an intra-articular unicondylar fracture
(one condyle sheared off);
 Type C – bicondylar fractures with varying
degrees ofcomminution.

Capitulum fractures
Bryan and Morey classification
Type I: Hahn-Steinthal fragment. Large osseous
component of capitellum, sometimes with
trochlear involvement
Type II: Kocher-Lorenz fragment. Articular
cartilage with minimal subchondral bone
attached: “uncapping of the condyle”
Type III: Markedly comminuted

Head of radius fractures
Mason classification
 Type I An undisplaced vertical split in the radial
head
 Type II A displaced single fragment of the head
 Type III The head broken into several
fragments (comminuted).

Radial neck fractures
 A fall on the outstretched hand forces the
elbow into valgus and pushes the radial head
against the capitulum.
 In children the bone fractures through the neck
of the radius; in adults the injury is more likely
to fracture the radial head.

Olecranon process fractures
Two broad types of injury are seen:
(1) a comminuted fracture which is due to a direct blow
or a fall on the elbow
(2) a transverse break, due to traction when the patient
falls onto the hand while the triceps muscle is
contracted.
These two types can be further sub-classified into
(a) Displaced
(b) Undisplaced fractures.
More severe injuries may be associated also
with subluxation or dislocation of the ulno-humeral
joint.

Olecranon process fractures
Morrey Classification
 Type I: Undisplaced, stable fractures
 Type II: Displaced, stable
 Type III: Displaced, unstable fractures

Coronoid process fractures
Regan and Morrey classification
Type I: Fracture avulsion just the tip of the
coronoid
Type II: Those that involve less than 50% of
coronoid either as single fracture or multiple
fragments
Type III: Those involve >50% of coronoid
Subdivided into those
(A)without elbow dislocation
(B)with elbow dislocation

Treatment
 Surgical treatment is given as appropriate
 Plates and screws for comminuted fractures
 Headless or lag screws for uncomminuted
fractures
 Collar and cuff for splinting or other splints in
non surgical intervention.

Physiotherapy mx
Problems
 Stiffness of the elbow
 Loss of extension and flexion and sometimes
pronation and supination
 Pain
 Myositis ossificans
 Vascular insufficiency
 Nerve damage (ulnar and median nerve)
 Mul union

Physio mx
Problems
 Delayed union
 Non union
 Elbow instability
 Muscle spasm
 Muscle weakness
 Muscle atrophy
 Joint deformity
 Bone infection (osteomyelitis)
 Osteoporosis loss of bone density as a result of reduced
functionality
 Thrombus formation

Physio mx
 Ultrasound to loosen adhesions/ myositis
ossificans
 Massage (hacking) and muscle stretch to
realese contractures
 Range of motion exercizes to increase
extension, flexion, supination and pronation.
 Tens/ift for pain medication and muscle spasm.

Physio mx
 Circulatory exercizes for vascular insufficiency
 Nerve glides for nerve damage if neuropraxic
 Nerve stretching
 Immobilisation in cast in cases of mal union,
delayed union and non union then refere for re
assesment.
 Immobilising in armsling for elbow instability.
Untill healing takes place.

 Muscle strengthening exercizes for muscle
weakness, muscle atrophy and immobility
osteoporosis.
 Order for a check x-ray if there is joint
deformity for appropriate progression of
therapy.
 with chronic uhealing wounds discharging pus
suspect osteomyelitis, and recommend biopsy
for microbiology examination.
 tubi grip will be appropriate for dvt (paget von
schruetter disease).

Elbow dislocations
 Posterior/ posterolateral
 Forward dislocation (side swipe)
 Lateral
 Anterior

Dislocations
General
• The most common type of dislocation in
children and the second most common type in
adults, second only to shoulder dislocation
• Young adults between the ages of 25–30 years
are most affected and sports activities
account for almost 50% of these injuries
• Mechanism: Fall on the outstretched hand

Clinical
• Dislocation can be anterior or posterior with
posterior being the most common, occurring
98% of the time.
• Associated injuries include fracture of the radial
head, injury to the brachial artery and median
nerve

Isolated dislocation of radial
head
 A true isolated dislocation of the radial head is
very rare; if it is seen, search carefully for an
associated fracture of the ulna (the Monteggia
fracture).
 In a child, the ulnar fracture may be difficult to
detect if it is incomplete, either green-stick or
plastic deformation of the shaft;
 it is very important to identify these incomplete
fractures because even a minor deformity, if it is
allowed to persist, may prevent full reduction ofthe
radial head dislocation.

 Symptoms
• Inability to bend the elbow following a fall on
the outstretched hand
• Pain in the shoulder and wrist
• On physical exam: The most important part of
the exam is the neurovascular evaluation of
 the radial artery, and median, ulnar and radial
nerves

 Imaging
• Plain AP and lateral radiographs
• CT and MRI scans are seldom necessary

 Treatment
• Reduce dislocation as soon as possible after
injury
• Splint for 10 days
• Initiate ROM exercises, NSAIDs

Complications
• Loss of ROM of elbow especially extension
• Ectopic bone formation
• Neurovascular injury
• Arthritis of the elbow

References
 Apley orthopaedic textbook
 Upper limb fractures
 Physical medicine and rahabilitation

Elbow fractures and dislocations

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