Elbow And Forearm Flashcards
What imaging would you request for a suspected humeral supracondylar fracture?
Plain film radiographs, AP and lateral views of the elbow.
CT may be needed for comminuted fractures / where there is intra-articular involvement, it can aid surgical planning.
What classification system is used for supracondylar fractures?
The Gartland classification system:
Type 1 - undisplaced
Type 2 - displaced with intact posterior cortex
Type 3 - displaced in 2/3 planes
Type 4 - displaced with complete periosteal disruption.
What is the management for a supracondylar fracture?
For fractures with neuro vascular compromise - immediate closed reduction + percutaneous K wire fixation. (Also type 2/3/4 need this anyway).
For type 1/2 fractures conservative management - above elbow cast in 90 degrees flexion.
Open fractures need open reduction with percutaneous pinning.
What are the two deformities that can arise as a complication of a supracondylar fracture?
Gunstock deformity (cubitus Varus)
Volkmann’s contracture (Caused by iscahemia, necrosis of the forearm flexor muscles, causing wrist to be permanently flexed).
How might an olecranon fracture present?
Inability to extend the elbow against gravity (due to disruption of the triceps mechanism).
What imaging would you request for a suspected olecranon fracture?
Plain film radiographs AP and lateral of the elbow (and potentially the joints above and below).
We may sometimes do a CT if it is a complex injury / there is
what is the management for an olecranon fracture?
A to E assessment
Analgesia
Conservative management (if displacement <2mm) - immobilisation in 60-90 degrees of flexion + early mobilisation after 1-2 weeks.
Surgical - (displacement >2mm) - tension band wiring / plating.
What is an Essex-Lopresti fracture?
A fracture of the radial head, with disruption of the distal radio-ulnar joint.
This will always require surgical intervention.
What imaging should be requested for a suspected radial head fracture?
Plain film radiographs AP and lateral of the elbow - might show a ‘sail sign’. (May also need to check the shoulder and wrist joints).
May need a CT to look at more complex injuries or MRI if there are associated ligament injuries.
How are radial head injuries classified?
The Mason classification.
Mason 1 - Minimally displaced (<2mm)
Mason 2 - partial articular + displacement or angular ion (>2mm)
Mason 3 - comminuted fracture + displacement (complete articular).
How are radial head fractures managed?
A to E assessment
Analgesia
Mason 1 - immobilisation with sling + early mobilisation.
Mason 2 - if no mechanical block, treat as type 1, if block they may need surgery (ORIF).
Mason 3 - Surgery, ORIF or radial head replacement.
What imaging should be requested for a suspected elbow dislocation?
A plain film radiograph AP and lateral views.
(CT may be used in a trauma setting / if there are associated fractures).
how should a dislocated elbow be managed?
Initial management - closed reduction with analgesia + sedation. Then above elbow backslab.
If the dislocation is complicated by a fracture the patient may need ORIF.
What is the terrible triad?
Elbow dislocation with:
1 - lateral collateral ligament injury
2 - radial head fracture
3 - coronoid fracture (ulna)
It causes a very unstable elbow. Treatment is operative fixation (bones need ORIF) and LCL needs reconstruction.
What investigations should be requested for a suspected olecranon bursitis?
plain film radiographs of the elbow may rule out bony injury.
Definitive diagnosis is from aspiration of the fluid, sent for microscopy and culture.
