Elbow Fracture: Difference between revisions

Revision as of 08:53, 8 February 2012

Radial Head

Background

Most common fractures of the elbow
Caused by FOOSH leading to radial head being driven into the capitellum
Associated injuries are common:
- Capitellum, olecranon, and coronoid fx, MCL injury, dislocation

Clinical Features

Pain in the lateral elbow, esp w/ pronation/supination of forearm
Swelling laterally and tenderness of radial head

Diagnosis

Imaging
- Fractures are often subtle
  - Look for abnormal fat pad
  - Look for radiocapitellar line disruption

Management

Sling immobilization in flexion, ice, elevation
Nondisplaced fx w/ no mobility restrictions: ortho f/u within 1wk
Displaced fx or mobility restricintons: ortho f/u within 24hr

Olecranon

Background

Occurs via direct trauma or by fall w/ forced hyperextension of elbow
Associated injuries are common:
- Dislocations, radial head fx, ulnar nerve injury

Clinical Features

Pain, swelling, and occasionally over posterior elbow
Forearm extension strength is reduced (triceps inserts at the olecranon)

Management

Rule-out ulnar nerve injury
Immobilize w/ long arm posterior mold w/ elbow in flexion and forearm neutral
Refer to ortho w/in 24hr

Source

Tintinalli

Authors:

@@ Line 1: / Line 1: @@
-==ADULT INJURIES==
+==Radial Head==
-===Radial Head/Neck Fractures===
+===Background===
-# 50% of elbow injury in adults
+*Most common fractures of the elbow
-# see Elbow Fx lect
+*Caused by FOOSH leading to radial head being driven into the capitellum
+*Associated injuries are common:
+**Capitellum, olecranon, and coronoid fx, MCL injury, dislocation
-===Olecranon Fx===
+===Clinical Features===
-# 2nd most common
+*Pain in the lateral elbow, esp w/ pronation/supination of forearm
-# 20%
+*Swelling laterally and tenderness of radial head
-# direct blow
-# pain,swelling, can't extend elbow
-# OR if > 2 mm stepoff
-===Elbow D/L===
+===Diagnosis===
-# 3rd most common jt D/L
+*Imaging
-# 90% post or postlateral
+**Fractures are often subtle
-# 50% have assoc injuries, most common is med epicondylar fx that can often get entrapped
+***Look for abnormal fat pad
-# prox radius & coronoid also Fxed
+***Look for radiocapitellar line disruption
-# ulnar injury - 8-21% in post D/L
-# higher rate of neurovasc injury in anterior D/L
-# Long arm post splint
-===Monteggia Fx/D/L===
+===Management===
-#Type I - prox 1/3 of ulna, ant displ of distal ulna & ant disl of radial head
+*Sling immobilization in flexion, ice, elevation
-##80%
+*Nondisplaced fx w/ no mobility restrictions: ortho f/u within 1wk
-#Type II - post displ of distal ulna & post D/L or radial head (20%)
+*Displaced fx or mobility restricintons: ortho f/u within 24hr
-# Dislocation of radial head requires ORIF
+==Olecranon==
+===Background===
+*Occurs via direct trauma or by fall w/ forced hyperextension of elbow
+*Associated injuries are common:
+**Dislocations, radial head fx, ulnar nerve injury
+===Clinical Features===
+*Pain, swelling, and occasionally over posterior elbow
+*Forearm extension strength is reduced (triceps inserts at the olecranon)
+===Management===
+*Rule-out ulnar nerve injury
+*Immobilize w/ long arm posterior mold w/ elbow in flexion and forearm neutral
+*Refer to ortho w/in 24hr
 ==See Also==