Elbow and Arm Flashcards
in what age group are supracondylar fractures most common and what is the main mechanism of injury
most common in aged 5-7 yrs.
most common paediatric injury and are almost never seen in adults
main mechanism is FOOSH with elbow in extension
supracondylar fractures are associated with a high risk of neurovascular injury, what nerves are essential to examine post fracture
median nerve
anterior interosseous nerve (deep motor branch of the median nerve)
radial nerve
ulnar nerve
what is the sensory and motor distribution of the median nerve
sensory = skin over the anterolateral surface of the hand (thumb and first 2 and a half digits)
motor = thumb flexion and opposition, wrist flexion, forearm pronation and flexion of digits 2 and 3
what is the sensory and motor distribution of the radial nerve
motor = arm, wrist and finger extension, forearm supination
sensory = most of the back of the hand
what is the sensory and motor distribution of the ulnar nerve
sensory = medial forearm, medial wrist and medial one and a half digits
motor = wrist flexion, finger adduction and abduction, flexion of digits 4 and 5
what are the 2 nerves of the hand
median nerve - supplies thumb and digits 2 and 3 (flexion and sensory)
ulnar nerve - supplies digits 4 and 5 (flexion and sensory)
Radial nerve (extension)
what are some signs of vascular compromise in the hand post supracondylar fracture
cool temp
delayed cap refill time
absent pulses
what is the classification system used in supracondylar fractures
Gartland classification system
what type of supracondylar fractures can be managed conservatively
type I and minimally displaced type II
management of supracondylar fractures with associated neurovascular compromise
immediate closed reduction
reduction then secured with K wires - which are removed in clinic after 4 weeks
what is a Volkmann’s contracture and how do they happen
occurs following vascular compromise with a supracondylar fracture
ischaemia and subsequent necrosis of the flexor muscles of the forearm - begin to fibrose and form a contracture
this results in the wrist and hand being held in permanent flexion as a claw-like deformity
what does the olecranon articulate with
trochlea of the humerus
what muscle inserts onto the olecranon
triceps brachii
where is the site of insertion for the triceps brachii muscle
olecranon
what main neurovascular function should you check that will indicate a olecranon fracture
extension of the elbow against gravity
disruption of the triceps mechanism
management of an olecranon fracture
conservative - for minimally displaced fractures, immobilise arm in 60-90 degrees elbow flexion and physio
surgical - for displaced fractures, tension band wiring or olecranon plating
what bony structure does the radial head articulate with to form the elbow joint
capitulum of the humerus
main mechanism of radial head fractures
FOOSH with arm in pronation
the radial head is pushed against the capitulum of the humerus
what is an Essex-Lopresti fracture
a fracture of the radial head with disruption of the distal radio-ulnar joint
will always require surgical intervention
what system is used to classify radial head fractures
classified according to degree of displacement and intra-articular involvement using the Mason classification system
Mason type 1 - non displaced
mason type 2 - partial articular fracture with minimal displacement
mason type 3 - comminuted fracture and displacement
management of radial head fractures
mason type 1 = short period of immobilisation in sling followed by early mobilisation
mason type 2 = if no mechanical block then treated as per type 1, if mechanical block is present then ORIF
mason type 3 = ORIF or radial head excision or replacement
when might a ‘sail sign’ be seen on lateral X-ray
radial head fracture
what is the most common type of elbow dislocation
90% are posterior dislocations
what muscles, tendons, ligaments stabilise the elbow joint
medial and collateral ligaments
common flexor and extensor origin tendons
anconeus, brachialis and triceps brachii
