Humerus and elbow

Question 1

Describe humours shaft fractures

Answer 1

Fracture of the humeral shaft commonly result from a direct blow to the arm, severe twisting or a foosh.
Usually fracture in the middle third of the shaft

Isolated fractures are treated conservatively. Attempts at fracture reduction and external immobilization are unnecessary and sometimes detrimental to healing. Undisplaced can be placed in a sugar tong cast. If the fracture is grossly displaced U slab. Hanging U cast has the disadvantage of using gravity for traction and is not effect if the patient is not upright.
20 degrees of angulation and 30 degrees of varus valgus is acceptable

Complications

• radial nerve injury - most often benign neuropraxia.
• Brachial artery and vein
• Ulnar and median nerve

Question 2

Discuss condylar fractures

Answer 2

Rare in adults and typically involve the articular surface and the nonarticular portion of the distal humerus including the epicondyle.

IN lateral condylar fracture finding may be accentuated with movement of the radius. In children lateral condyle fractures are the second more common fracture involving the elbow. Because of the location of the radial nerve it is imperative to test it function when a lateral condyle fracture is present

Medical condylar fractures are rare in children and when they do occur they are considered salter harris 4 injuries. ulnar nerve

Question 3

Describe epicondylar fractures

Answer 3

Most epicondylar fractures involve the medial epicondyle. Most common in children and adolescents and often involve the apophyisis which is the last ossifiection centre to fuse in the distal humerus usually after 15.

Minimally dispalced <5mm treatment with a posterior splint is appropriate.

Question 4

Describe olecranon fracutres

Answer 4

May result from direct blow or result of a fall, MVA or assault. Uncommon in chjildren. Inability to extend the elbow against force indicates complete discontinuity of the pulling mechanisms and the consequent failure of the triceps fucntion.

Neurovascularly ulnar nerve should be inspected. Loss of sensation over the palmar aspect of the 5th digit and hypothenar eminence or motor weakness of the interossei suggest motor weakness

Displacement of more than 2mm is indication for surgery

Question 5

Discuss radial head and neck fractures

Answer 5

FOOSH - radius transmits force upward driving the radial head into the capitellum and resulting in a fracture fo the weaker radial head or nekc.

Masons classification

1) undisplaced
2) marginal fractures (involving >30% of the articular surface) with more than 2mm of displacement, including impaction and angulation
3) communinuted fractures of the entire head
4) any of the previous with dislocation

Management
Type 1 treated with sling support and early ROM exercises. Aspiration of haemarthrosis may be give relief.
Surgical treatment for most type 2 and above

Question 6

Discuss elbow dislocation

Answer 6

Disruption of the relationship between the humerus and the olecranon. In general the radius and ulna bound together firmly by the annular ligament and interosseous membrane displace as a unit.

Most commonly dislocated posteriorly but can dislocate in any direction. Requires large amount of force and is often associated with fractures of adjacent bony structures and fracture dislocation.

Complications

• ulnar nerve is the most commonly affected in dislocation
• Vascular - injury to the brachial artery in 5-13% of cases
• Median nerve traction and entrapement
• compartment syndrome

Management
reduction as you would think