Elbow and Distal Radius Flashcards
Most elbow dislocations occur in what direction?
What is usually the mechanism of injury?
Posterior
FOOSH
What is the management for a pure elbow dislocation with no associated fractures?
Reduce (assessing neurovascular status before and after)
Sling for a week
Physio
If an elbow dislocation is causing instability problems, how can this be treated?
Lateral elbow ligament reconstruction
What structures may fracture as a result of an elbow dislocation?
Radial head
Ulna
Corcoid
Humeral epicondyles
What is the treatment for elbow dislocation with a radial head fracture?
What is the treatment for elbow dislocation with a humeral epicondyle fracture?
What is the treatment for elbow dislocation with a large coranoid fracture?
ORIF / Excision and replacement
Large screw
ORIF with small screw
Are distal humeral fractures usually intra or extra articular?
How are these treated?
When may elbow replacement be considered?
Intra-articular (elbow)
ORIF
Highly comminuted fractures in the elderly
What is the mechanism of injury behind an olecranon fracture?
Fall onto the elbow with triceps contraction
What is usually the treatment for an olecranon fracture?
What is used if it is only a simple transverse avulsion fracture?
ORIF with plates and screws (to restore triceps function and articular surface)
Tension band wiring
What is usually the mechanism of inury for distal radial head/neck fractures?
What movements is the radial head important for?
FOOSH
Pronation and supination
Fractures of the radial head often occur alongside what other injury?
Elbow dislocation
What is seen in this image?
What type of x-ray is needed to see this?
When will there be pain with this injury?
Fat pad sign- radial head fracture
Lateral elbow x-ray
Supination/pronation
How are minimally displaced, marginal radial head fractures treated?
What function is often lost in patients with radial head fractures?
Conservative: sling followed by early elbow exercises to minimise stiffness
10-15 degrees of terminal extension
How should radial head fractures with displaced fractures and large fragments blocking movements be treated?
How should comminuted radial head fractures be treated?
Internal fixation and removal of fragments blocking movement
Exision +/- replacement
In patients with radial head fractures, what can be done to assess whether a patient actually has an obstrucution to movement or if it is only caused by pain?
Aspiration of haemarthrosis
Injection of local anaesthetic
What should you always suspect when there is a fracture of one of the bones of the forearm?
That there will be a fracture or dislocation in the other bone of the forearm
What is a Galeazzi fracture?
Fractured radius
Dislocated ulna at DRUJ
If a patient has an isolated radius fracture, what imaging should you request?
Lateral wrist x-ray
What is a Monteggia fracture?
Fractured ulna
Dislocated radial head at the radiocapitellar joint
If a patient has an isolated ulna fracture, what other imaging should you request?
Elbow x-ray
What is a Nightstick fracture?
An isolated fracture of the ulna from a direct blow
If both bones of the forearm are fractured, how is this managed?
ORIF
How are Monteggia and Galeazzi fractures treated?
ORIF of the fractured bone, this should reduce the fracture
How are Nightstick fractures managed?
Mainly conservatively- ORIF can bring around quicker restoration of function and decrease the risk of non-union however
Colles fractures are often associated with what other fracture?
Ulnar styloid
What is the mechanism of injury of a Colles fracture?
Are these intra or extra articular?
What direction will these angulate/displace?
FOOSH with the wrist extended
Exra-articular (within 1 inch)
Dorsally
What are some complications of Colles fractures?
Median nerve compression / bleed in the carpal tunnel
EPL rupture
Complex regional pain syndrome
Loss of grip strength
How is an EPL tendon rupture as a result of a Colles fracture treated?
Tendon transfer
How do you treat a minimally displaced, angulated Colles fracture?
What is the normal angulation of the radius articular surface?
How do you treat a Colles fracture which is beyond this normal degree of angulation?
Splintage
10 degrees volarly
Manipulation
How is a Colles fracture usually held in place after manipulation?
If it has dorsal comminution or is felt to be particularly unstable after reduction, what is done?
Cast
Percutaneous wires OR ORIF with plates and screws
Some distal radius fractures are so comminuted that stable fixation of the joint fragment is not possible.
What can be used to hold the wrist in reasonable alignment?
External fixation
Supplementary wires
What is the mechanism of injury of a Smith’s fracture?
Are these intra or extra articular?
What direction are they displaced/angulated?
Fall onto the back of the hand
Extra
Volarly
Smith’s fractures are very unstable. How are they treated?
What are some complications?
ORIF
Grip strength and wrist extension are greatly reduced
Excessive volar angulation can cause malunion
What type of fractures are Barton’s fractures?
How are they treated?
Intra articular fractures of the volar or dorsal rim, associated with subluxation of the carpal bones
ORIF
A volar Barton’s fracture is the same as what?
A dorsal Barton’s fracture is the same as what?
Intra-articular Smith’s fracture
Intra-articular Colles’ fracture
