elbow/forearm and wrist fractures Flashcards by Kelliane Tambe

different fractures in the distal humerus

Supracondylar
Lateral Epicondyle
Medial Epicondyle
Y-shaped

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what is an elbow supracondylar fracture and how is it caused?

Fall on hand with elbow bent
Fracture in line of condyles
Distal fragment displaced posteriorly

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complications that arise from supracondylar fracture

Vascular problems
Volkmann’s ischaemic contracture
Compartment syndrome
Median nerve damage
Myositis ossificans

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types of supracondylar fracture

undisplaced and unstable

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management of undisplaced supracondylar fracture

Reduction - elbow flexed > right angle
Cast with elbow flexed
Collar + cuff x3/52

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management of unstable supracondylar fracture

Difficult realignment
Monitor blood supply
ORIF (wires)
Cast with elbow flexed 3-4/52

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cause intercondylar fracture

Fall

Blow to elbow

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types of intercondylar fractures

Unicondylar
Bicondylar 
 - Coronoid driven between two halve of trochlea 
   -Y-Shaped 
   -T Shaped  
Undisplaced 
Displaced 
Comminuted

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management of undisplaced intercondylar fractures

Unicondylar

Cast in elbow flexion position x 4-6 weeks (+C+C)

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management of displaced/comminuted intercondylar fracture

ORIF
Wires
Plate and Screws
Cast in elbow flexion position x 4-6 /52 (+C+C)

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complications of post intercondylar fracture

elbow stiffness - loss of full extension
long term risk of OA
ulnar nerve palsy - clae hand - flexion of last 2 digits
weak / unable to abduct/adduct fingers

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cause of fracture of olecranon

Direct -Fall on point of elbow

Indirect (Avulsion)- strong triceps contraction

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management of hairline/undisplaced olecranon fracture

Hairline / undisplaced

Long arm POP 6-8 /52 in elbow flexion

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management of displaced olecranon fracture

ORIF e.g. tension band wiring

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management of comminuted olecranon fracture

excision

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causes of dislocated elbow

Fall outstretched arm in extension (adults and children)

Displaced distal fragment over coronoid process

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complications of dislocated elbow

Joint stiffness
Ectopic ossification
Recurrent dislocation
Nerve damage: median/ulnar- uncommon

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management of dislocated elbow

Reduce
Collar+cuff 2-3 wk
Early mobilisation

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fractures radial head causes

Fall on outstretched arm

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undisplaced radial head fracture management

Aspirate blood from joint.

Supportive bandage collar + cuff early mobilisation

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management of displaced radial head fracture and angulation

ORIF

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management of comminuted radial head fracture and angulation

Radial head excision with early mobilisation

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monteggia fracture

proximal fracture of ulna and radial head dislocation

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cause monteggia fracture

fall on outstretched fully pronated arm

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management of monteggia fracture

ORIF –plate fixation of ulna Cast above elbow in 90º flexion to below wrist and in supination x 4-6 weeks NB Physio post cast

galeazzi cause

by fall on outstretched hand

galeazzi fracture

distal 1/3 radius shaft # | associated distal radioulnar joint (DRUJ) injury

complication of galeazzi

Mal-union | Unstable distal fragment

management of galeazzi

ORIF-plate and screws | Cast as for Monteggia

fracture of radius and ulna

Twisting injury / rotational deformity

complications of radius and ulna fracture

Mal-union Non-union Compartment syndrome

conservative management of radius and ulna fracture

Seldom successful - difficult due to unopposed supination  rotational deformity / slippage or ORIF - for both

acute compartment syndrome affects what compartment

volar compartment

acute compartment syndrome affects what muscles and why

flexor pollicis longus flexor digitorum profundus most vulnerable due to proximity to bone

acute compartment syndrome affects what nerves and arteries

Median nerve | Brachial Artery

if acute compartment syndrome is untreated it can result in

Volkmann’s Ischaemic Contracture.

how does the pressure change in acute compartment syndrome

Normal resting pressure= 0- 8mmHg Abnormal= 30mmHg –requires immediate decompression fasciotomy can cause irreversible damage to nerves

symptoms of compartment syndrome

``` Pain++ Swelling+ Numbness Paraesthesia (P+Ns) Painful ROM ```

complications of compartment syndrome

Muscle necrosis | Excision or debridement of necrotic muscle tissue

management of acute compartment syndrome

Immediate decompression fasciotomy - until pressure is released is prescribed antibiotics to prevent infections

3 types of fracture distal radius

colles fracture smiths fracture bartons fracture

colles fracture location

low energy, dorsally displaced, extra-articular Most common within 1 inch wrist joint

smiths fracture location

low energy, volarly displaced of distal segment, extra-articular

bartons fracture location

Intra-articular fracture

cause of colles fracture

fall on outstretched hand | Common in middle-aged and elderly women

5 elements of colles fracture

``` Backward angulation Backward displacement Radial deviation Supination Proximal impaction ```

complications of colles fracture

``` Complex regional pain syndrome (CPRS)- Sympathetic Nervous system dysfunction - Severe Pain - Swelling - Stiffness - Skin discolouration carpal tunnel syndrome rupture EPL tendon Mal-union deformity ```

conservative management of colles fracture

Manipulation under anaesthetic (MUA) disimpact fracture, flex wrist, pull hand into ulnar deviation POP short-arm cast (below elbow) for 4 – 6/52 and C+C Removal POP + refer to physiotherapy

ORIF management of colles fracture

K-wires (removed when fracture healed) POP as above for up to 6/52 Physio post removal of cast

smiths fracture cause

Patient lands with wrist in flexion

smiths fracture has risk of

deformity

management of smiths fracture

``` Reduction of fracture Long arm plaster Above elbow, Arm in supination + wrist ext + elbow flex Remove POP 6 weeks Refer to physiotherapy ```

bartons fracture cause

fall on extended and rotated wrist

fracture line in bartons fracture

Fracture line runs into joint- intra-articular fracture Distal fragment can displace anteriorly or posteriorly

how does bartons fracture differ from smith and colles

of carpal displacement

management of bartons fracture

Generally requires ORIF to ensure stabilisation. Important to restore the radiocarpal joint integrity + Below Elbow cast

short arm cast fixation is for

forearm or wrist fracture

long arm cast fixation is for

upper arm, elbow or forearm fracture

physio treatment for distal fracture

``` Swelling management- POLICE Strengthening & ROM exercises Wrist HEP - self assisted Check other joints for ROM especially fingers, thumb and elbow. Elbow may be stiff if long arm cast was used. Manual therapy once fracture well healed Hand function Gross grip Fine grip activities ```

exercises for ROM wrist fracture

wrist flexion/extension wrist radial ulnar deviation pronation /supination

exercises following wrist fracture

grip strength