Elbow Fractures + Dislocations + Related Injuries

supracondylar fracture

fracture of the humerus just above the condyles;

trauma

supracondylar fracture treatment

ORIF —> rehab

3-4 weeks = sling (take off for ROM exercises)

followed by comprehensive rehab

supracondylar fracture complications

potentially limb threatening due to network of nerves and blood vessels (median, radial, ulnar nn and brachial a) —> Volkman’s ischemic contracture or Myositis ossificans

humeral medial epicondyle fracture

fracture/avulsion of the medial epicondylar epiphysis (insertion of the wrist flexors), mostly in adolescents;

direct trauma, repetitive valgus stress overload w/ pitching

humeral medial epicondyle fracture treatment

ORIF —> rehab

5-10 days later = start motion

3-4 months = throwing

screw eventually removed

radial head fracture

fracture of the radial head, wide variety (non-displaced/displaced, single/several fragments);

fall on outstretched arm causing compression between the radial head and capitulum

radial head fracture treatment

not displaced —> early motion

displaced —> ORIF, early motion, rehab

comminution —> resection, potential head replacement

radial head fracture complications

length of the radius = concern

not maintaining relative anatomical relationship of radius and ulna

olecranon fracture

fracture/avulsion of the olecranon process;

direct trauma, forceful contraction of the triceps

olecranon fracture treatment

ORIF —> prolonged rehab

complex fracture

multiple fractures potentially affecting the distal end of the humerus and proximal ends of the radius and ulna;

significant direct trauma

complex fracture treatment

ORIF —> rehab

complex fracture complications

permanent limited ROM, permanent malalignment

night stick fracture

isolated fracture of the ulna;

direct trauma

night stick fracture treatment

splint or ORIF —> rehab

both bone forearm fracture

fracture of mid-shaft of radius and ulna;

direct trauma

both bone forearm fracture treatment

ORIF —> rehab

monteggia’s fracture

fracture of ulna with dislocation of head of radius;

direct trauma

monteggia’s fracture treatment

ORIF —> rehab

galeazzi’s fracture

fracture of distal shaft of radius w/ subluxation/dislocation of distal radioulnar joint;

direct trauma

galeazzi’s fracture treatment

ORIF —> rehab

colles fracture

fracture of the distal end of the radius w/ dorsal displacement of distal segment (silver fork deformity);

fall on outstretched arm

colles fracture treatment

typically external reduction + immobilization —> rehab

occasionally ORIF

smith fracture

fracture of the distal end of the radius w/ ventral displacement of distal segment (garden spade deformity);

fall on outstretched arm

smith fracture treatment

typically external reduction + immobilization —> rehab

radial head dislocation (adult)

most often combined w/ fracture of ulna (Monteggia fracture), isolated dislocation is rare;

forced pronation for isolated dislocation

radial head dislocation (adult) treatment

ORIF —> prolonged immobilization

radial head dislocation (children)

radial head slips in a distal direction out of annular ligament, called nursemaid’s elbow or transient subluxation;

lifting or pulling the child by the hand w/ elbow extended (and forearm pronated)

radial head dislocation (children) treatment

reduced by pushing forearm upwards and rotating it alternately into supination and pronation —> wear sling w/ elbow flexed and supinated

myositis ossificans

ossification of brachialis muscle

secondary to:

• injury (contusion) to the brachialis muscle OR

• supracondylar (or complex) fracture w/ related soft tissue injuries affecting the brachialis OR

• elbow dislocation w/ related soft tissue injuries affecting the brachialis

myositis ossificans treatment

prevention through avoidance of repetitive injuries and/or prolonged inflammation

• avoid reinjuries

• avoid heat and massage during acute/sub-acute painful stages

  • gentle ROM w/in tolerance

myositis ossificans natural history

1) metabolically active stage

• progressive calcification of the brachialis over several weeks/months

• monitor w/ bone scan

• rest + gentle ROM

2) once no longer metabolically active

• treatment consists of progressive ROM and strengthening exercises