2.05 Trauma and Orthopaedics - The Elbow Flashcards
Give some factors that contribute towards elbow joint stability.
- humeroulnar joint
- radiocapetellar joint
- joint capsule
- medial and collateral ligaments
- common flexor and extensor origin tendons
- surrounding musculature (ie. anconeus, brachialis, triceps brachii)
What are the clinical features of elbow dislocation?
- typically present following high-energy fall
- painful and deformed joint
- swelling
- decreased function
What neurovascular findings are common OE of elbow following dislocation?
- neuropraxia of the ulnar nerve causes deficit in the territory of the ulnar nerve
- elbow has rich collateral circulation, so good capillary refill even in those with arterial injury
What investigations can be used to assess elbow dislocation?
- plain film radiographs (AP and lateral)
What X-ray findings are consistent with an elbow dislocation?
Loss of radiocapitellar and ulnotrochlea congruence.
How is elbow dislocation managed?
- closed reduction
- sufficient analgesia / sedation
- apply above elbow backslab
- plain film radiograph to confirm reduction
If the dislocation is complicated by a fracture, open type injury, or has neurovascular compromise, ORIF may be used to surgically fix the injury.
What are the common complications of elbow dislocation?
- neuropraxia of the ulnar nerve
- recurrent instability
- early stiffness
What is the terrible triad of an elbow dislocation?
An elbow dislocation associated with:
1) lateral collateral ligament injury
2) radial head fracture
3) coronoid fracture
The combination of injuries causes a very unstable elbow, and patients are likely to have recurrent problems with instability, stiffness and arthrosis.
Treatment involves ORIF and surgical reconstruction of LCL.
What is the common aetiology of olecranon bursitis?
Repetitive flexion-extension movements at the elbow causes irritation of the bursa, due to its superficial position and its vulnerability to pressure and trauma.
What are the clinical features of olecranon bursitis?
- pain and swelling
- range of motion preserved
- systemic symptoms
What are the differential diagnoses for olecranon bursitis?
- inflammatory arthropathies
- gout
- cellulitis
- septic arthritis
What investigations can be used to assess olecranon bursitis?
- bloods (FBC, CRP)
- serum urate if history is suggestive of gout
- ACPA if history suggestive of rheumatological cause
- plain film radiograph to rule out bony injury
- aspiration of fluid for microscopy and culture (GOLD STANDARD)
How is olecranon bursitis treated?
Swellings without infection can be treated with analgesia and rest.
If infection is present, IV abx and surgical drainage / washout indicated.
What are the main complications of infected olecranon bursitis?
- septic arthritis
- osteomyelitis
Most cases will resolve spontaneously
What is epicondylitis?
A chronic and symptomatic inflammation of the forearm tendons at the elbow, classified as an overuse syndrome in the elbow.
Caused by microtears in the tendons following repetitive injury.
Out of lateral and medical epicondylitis, which is more common?
Lateral epicondylitis is more common, affecting 4-7 people per 1000 per year.
What is the pathophysiology of lateral epicondylitis?
Repetitive overuse of common extensor tendon causes microtears at its origin (lateral epicondyle).
This leads to the formation of granulation tissue, fibrosis and eventually tendinosis.
What is the main risk factor for lateral epicondylitis?
Occupations and hobbies that are associated with excessive use of extensive forearm muscles.
Commonly named tennis elbow.
Which x-ray findings are consistent with a supracondylar fracture?
- posterior fat pad sign
- displacement of anterior humeral line
CT imaging may be useful to aid surgical planning.
What classification system is used to grade supracondylar humeral fractures?
Gartland classification system
How are supracondylar fractures managed?
- immediate closed reduction is neurovascular compromise
- above elbow cast at 90° flexion if undisplaced
- percutaneous K-wire fixation if displaced
- open reduction with pinning if open fracture
Outline the pathophysiology of Volkmann’s contracture following supracondylar humeral fracture.
- fracture causes vascular compromise to flexor muscles of the forearm
- flexor muscles necrose and then fibrose
- contracture forms, resulting in the wrist and hand to be held in a permanent flexion, claw-like deformity
What investigations are warranted to diagnose olecranon fracture?
- routine blood tests, incl. clotting screen and group and save
- AP and lateral plain film radiograph
Which x-ray findings are consistent with a radial head fracture?
- elbow effusion
- fat bad sign
- fracture line in radial head
What is a Essex-Lopresti fracture?
A fracture of the radial head and dislocation of the distal radio-ulnar joint.
Important to assess wrist and shoulder joint when assessing elbow injury.
