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NMSK 2 - upper limb > elbow fractures and instabilities > Flashcards

elbow fractures and instabilities Flashcards

1
Q

compare the locations of an extra-articular vs intra-articular distal humerus fracture

A
  1. extraarticular - supracondylar
  2. intraarticular - lateral or medial epicondyle, intercondylar, capitellum
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2
Q

what is the MOI of paediatric elbow fractures?

A

fall on outstretched hand

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3
Q

Describe a supracondylar fracture

A

-most common in children aged 5-10
-MOI= fall on hand with elbow extension
-MOI2 - direct anterior force against a flexed elbow
-very uncommon in adults

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4
Q

what are neurovascular complications from a supracondylar fracture?

A

-injury to the brachial artery
-compartment syndrome
-volkmanns ischaemic contracture (due to inadequate treatment of compartment syndrome0 - shortening of forearm flexors
-median nerve damage

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5
Q

what are other complications of supracondylar fractures other then neuromuscular?

A

-myositis ossificans - in brachialis region
-cubitus varus - malunion

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6
Q

what is the symptoms associated with a median nerve injury?

A

-ape hand
-hand of benediction
-tinel sign (tapping median nerve - imitates symptoms in hand)

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7
Q

describe an intracondylar fracture in children (lateral vs medial condyle)

A

-lateral condyle - common in children
-medial condyle - more common in early teens & males

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8
Q

describe a radial head and neck fracture in children

A

-1-5% of paediatric elbow fractures
-radial head subluxation can also occur

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9
Q

describe olecranon fractures in children

A

-uncommon
-can occur with radial head and neck fractures

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10
Q

how are displaced vs non displaced supracondylar fractures managed?

A

-non displaced - long arm splint and progress to cast w/ elbow at 90 deg flexion & forearm nuetral
-displaced - surgery to reduce and fix followed by splint or cast for 3-4 weeks

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11
Q

how are lateral condyle fractures managed?

A

splint / cast for 6 weeks

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12
Q

how are medial condyle fractures managed if they require surgery?

A

-shorter splint / cast time
-1-2 weeks

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13
Q

how many degrees displacement of the radial head requires surgery?

A
  • more than 30
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14
Q

how are intercondylar fractures managed in adults?

A

-undisplaced or unicondylar fractures generally managed conservatively
-displaced or comminuted fractures can require surgery to fix
-difficult to fix as many bone fragments & loss of mineral density
-donjoy brace in flexion initially

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15
Q

what are examples of complications post interconydlar fracture in adults?

A

-elbow stiffness - asp loss of full extension
-early mobilisation generally recommended
-long term risk of OA if fracture extends into the elbow joint
-ulnar nerve palsy

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16
Q

what are some symptoms associated with ulnar nerve damage?

A

-muscle weakness in hand
-decreased grip strength
-muscle wasting - hypothenar eminence
-numbness, pain and tingling in hand
-clawing of 5th and 5th digits

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17
Q

what age groups most commonly suffer from a olecranon fracture?

A

-patient aged 50+
-if younger- high trauma injury

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18
Q

what are the causes of a fractured olecranon?

A

-direct - fall on point of elbow
-indirect - strong triceps contraction causing avulsion

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19
Q

how are hairline or undisplayed olecranon fractures managed?

A

-POP / donjoy cast in flexion
-early mobilisation in brace with avoidance of full flexion

20
Q

how are displaced olecranon fractures managed?

A
  • ORIF
21
Q

what is the MOI for a dislocated elbow & which direction of dislocation is most common?

A

MOI= Fall with outstretched arm In extension
-posterolateral direction most common

22
Q

if there is an anterior dislocation of the elbow, what can also be associated with it?

A

a fracture

23
Q

how are dislocated elbows managed?

A

-reduce (correct misalignment)
-early mobilisations, work into extension
-collar and cuff

24
Q

what are examples of complications post elbow dislocation?

A

-joint stiffness
-instability
-heterotrophic ossification (formation of mature lamellar bone in extra osseous tissue)
-recurent dislocation
-nerve damage eg medial - ulnar - but this is uncommon

25
Q

what is the terrible triad of the elbow?

A

-posterior lateral elbow dislocation
-radial head fracture
-coronoid fracture

26
Q

how is the ‘terrible traid’ repaired / managed?

A
  • restore the lateral column (radial head and radial collateral ligament) of the elbow
    -avoid the development of posterior lateral instability
27
Q

what is the MOI for a radial head fracture?

A
  • fall on outstretched arm with wrist extended and forearm pronated
28
Q

how are simple and non displaced radial head fractures managed?

A
  • non operative treatment
    -sling for comfort
    -keep moving - flex/ext of elbow, and as pain settles - sup and pro
29
Q

how are displaced radial fractures managed?

A
  • reduce and apply stable fixation
  • for severe communication fractures, may need radial head replacement to prevent instability
30
Q

what are the 2 main ligaments of the elbow?

A

-lateral collateral ligament
-medial collateral ligament

31
Q

Describe an ulnar collateral ligament sprain

A

-also called medial ulnar collateral ligament
-acute injury or repeated valves stresses due to throwing eg javelin
-acute or chronic onset
-valgus laxity

32
Q

describe the symptoms associated with acute or chronic ulnar collateral ligament sprain?

A
  1. acute - hear a ‘pop’
  2. pain with reduced throwing power
33
Q

what is the primary structure resisting valgus stress?

A

-UCL/ medial ulnar collateral ligament

34
Q

how does throwing affect the UCL?

A

-places repetitious high valgus stress on the medial aspect of the elbow joint and UCL
-produces microscopic tears and could eat to rupture of weakened ligament overtime

35
Q

what can ligamentous insufficiency lead to?

A

-degenerative or traumatic arthritis w/ osteophytic formation

36
Q

what are signs and symptoms of UCL sprain?

A

-medial elbow pain generally on activity
-localised tenderness over ligament
-pain w/ valgus stress test + laxity seen
-may or may not have ulnar nerve injuries

37
Q

what can posterolateral rotatory instability (PLRI) caused by?

A

-a weak lateral collateral ligament complex, esp a weak lateral ulnar collateral ligament

38
Q

what happens to the proximal radius and ulna in posterolateral rotaory instability?

A

-proximal radius and ulna externally rotate together as a unit in relation to the humerus causing posterior subluxation or dislocation of the radial head relative to the capitellum

39
Q

what are the signs & symptoms of posterolateral rotatory instability?

A

-generally younger people and females
- may or may not have lateral elbow pain
-often full range of motion
-positive pivot shift test / push up test etc
-may have various laxity

40
Q

what are the aims of physiotherapy for elbow fracture / instability management ?

A

-guided by orthopaedic team
-provide patient w/ pain free, stable functional elbow
-mobilise ASAP after trauma - active assisted, active ROM
-fitting of donjon brace/ splint/ support
-ROM & strength in unaffected joints eg wrist and shoulder
-manual therapy as indicated w/ grades guided by healing stage

41
Q

what is the motion arc for elbow flexion?

A

30-120deg

42
Q

what is the motion arc for pronation & supination?

A

50 deg for pro and sup

43
Q

what are examples of early protected ROM exercises for lateral instability eg for pro/sup and flex/ext?

A

-supine overhead position with the shoulder flexed to 90 deg
- for pro/sup - forearm resting on forehead, gentle active assisted supination & pronation is performed
-flex/ext- forearm is held in full pronation and gentle active and active assisted elbow flexion to full range & elbow extension (not past 30deg)

44
Q

what does stage 1 of elbow rehab involve?

A

-protected ROM to active ROM as healing progresses

45
Q

what does stage 2 of elbow rehab involve?

A

-start strengthening & weight bearing (around 6 weeks +)

46
Q

what does stage 3 of elbow rehab involve?

A

-progress strength - add speed etc
-pylometrics
-throwing training if required

NMSK 2 - upper limb (16 decks)

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