Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Orthopaedics > The Elbow > Flashcards

The Elbow Flashcards

1
Q

How do supracondylar humeral fractures occur and who gets them?

A

Common paediatric elbow injury (almost never adults)

Peak 5-7yrs
FOOSH (most common)
Landing flexed elbow (<10%)

Thorough assessment neurovascular structures needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Clinical features of supracondylar humeral fractures

A

Recent trauma
Sudden onset severe pain

Gross deformity
Swelling
Limited range movement
Ecchymosis

Median, anterior interosseous, radial, ulnar N - potential damage
Vascular compromise - cool temp, delayed capillary refill, absent pulses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Investigations of supracondylar humeral fractures

A

Plain film radiograph AP & lateral (posterior fat pad sign, displacement of anterior humeral line)

CT - comminuted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Garland classification of supracondylar humeral fractures

A

Type 1 - undisplaced
Type 2 - displaced with intact posterior cortex
Type 3 - displaced 2/3 planes
Type 4 - displaced complete periosteal disruption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Management of supracondylar humeral fractures

A

Associated NV compromise - immediate closed reduction

Conservative trialled type 1/ minimal,y displaced type 2 - above elbow cast 90d flexion

Surgical

  • Closed reduction & percutaneous K-wire fixation
  • open fractures open reduction with percutaneous pinning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Complications of supracondylar humeral fractures

A
  • nerve palsies
    Neuropraxia 10% rarely permanent
    Anterior interosseous N mostly
  • Malunion
    May develop cubital varus deformity (gunstock)
  • Volkmann’s contracture
    Following vascular compromise
    Ischaemia flexor muscles -> claw like
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pathophysiology & clinical features of olecranon fractures

A

Bimodal

All intra- articular fractures
Typically indirect trauma FOOSH -> sudden pull triceps
Younger direct trauma

Clinical features: 
Elbow pain
Swelling 
Lack mobility
Tenderness
Inability extend elbow 
Shoulder &amp; wrist should be checked
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Investigations & management of olecranon fractures

A

Routine bloods (clotting, G&S)

Plain AP & lateral radiographs
(Degree displacement)

CT - more complex injuries

Management:
Resus
Analgesia

Non- operative (displacement <2mm) immobilisation 60-90d elbow flexion, range of motion 1-2wks

Operative:
Tension band wiring, olecranon plating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which structure does the olecranon articulate with?

A

Trochlea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

In an olecranon fracture which muscle displaces the proximal fracture fragment?

A

Triceps brachii

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the most common fracture of the elbow?

A

Radial head fractures (1/3rd)

20-60yrs, fms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pathophysiology & clinical features of radial head fractures

A

Typically indirect trauma - axial loading forearm -> radial head pushed against capitulum

Features:
FOOSH
Elbow pain
Crepitation &amp; pain supination &amp; pronation 
Elbow effusion 
Shoulder &amp; wrist checked
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Investigations radial head fractures

A

Routine bloods
(Clotting & G&S)

Plain AP & lateral radiographs (elbow effusion - sail sign elevation anterior fat pad)

CT - more complex injuries, degree of comminution

MRI - more complex injuries, degree comminution, ligament injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Mason Classification of radial head fractures

A

According to the degree of displacement & intra articular involvement

Mason type 1 - non/ minimally displaced (<2mm)
Mason type 2 - partial articular fracture with displacement (>2mm or angulation)
Mason type 3 - comminuted fracture & displacement (complete articular fracture)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Management of radial head fractures

A

Resus
Stabilised
Analgesia

Check neurovascular compromise
Management based on mason classification
1 - non op, <1wk immobilisation sling
2 - no mechanical block - as above
May need surgery open reduction internal fixation
3 - nearly always surgery ORIF/ radial head excision or replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which bony structure does the radial head articulate with to form the elbow joint?

A

Capitulum of humerus & proximal ulna

17
Q

What is an Essex-lopresti fracture?

A

Fracture of radial head with disruption/ dislocation distal radio-ulna joint

✅surgery always

18
Q

Who tends to get elbow dislocations? In what two ways can they be defined?

A

Young adults
(Rare children - suspect supracondylar humeral fracture)
25% elbow injuries

Simple
Complex - associated concomitant fracture

90% occur posteriorly
50% suffering bony injury

19
Q

How is the elbow joint stabilised?

A

Primary static stabilisers - humeroulnar joint, medial/ collateral ligaments

Secondary static - radiocapetellar joint, joint capsule, common flexor & extensor origin tendons

Dynamic stabilisers - surrounding musculature: anconeus, brachialis, triceps brachii

20
Q

Clinical features of elbow dislocations & investigations

A

High energy fall typically

Painful
Deformed
Swelling
Decreased function

NV examination essential

Investigations:
Resus
Stable - plain film radiograph AP Lateral (loss radiocapiteller & ulnotrochlea congruence)

CT - adjunct fractures

21
Q

Management of elbow dislocations

A 
Closed reduction 
Analgesia
\+/- sedation 
Above elbow backslab once reduced keep at 90d
- in line traction 
- manipulation olecranon 
-> flexed 90d -> backslab
Radiograph confirm

Immobilisation 5-14days
Early rehab

If fracture/ open/ NV compromise - operative fixation
Open reduction & internal fixation
Soft tissue repair

22
Q

What is the terrible triad injury?

A

Elbow dislocation with
Lateral collateral ligament injury
Radial head fracture
Coronoid fracture

-> v unstable

Posterolateral dislocation
Recurrent problems likely

✅operative fixation

23
Q

What is epicondylitis? What are the two types?

A

Chronic symptoms inflammation of forearm tendons at elbow
Overuse syndrome
Microtears tendons -> granulation tissue -> tendonitis
35-54yrs

Lateral epicondylitis (tennis elbow) more common 
Medial epicondylitis (golfers elbow)
24
Q

Clinical features of epicondylitis & two test for lateral epicondylitis

A

Pain elbow radiation down
Worsens over weeks to months

Tenderness

Tests of LE:
➕ pain
- Cozen’s test
Elbow held flexed 90d, hand over LE, pts hand radially deviated forearm pronated - pt extend wrist against resistance
- Mill’s test
LE palpated whilst pronating forearm , flexing wrist, extending elbow

25
Q

Investigations & management of epicondylitis

A

Clinical
USS/ MRI confirm

Management:
Modify activities
Analgesics 
Corticosteroid injections
Physiotherapy

Surgical:
Not controlled conservatively
Open/ arthroscopic debridement of teninosis &/or release or repair of any damaged tendon insertions
>50% damage tendon transfer

LE Spontaneously improves 80-90% 1-2yrs

ME -tenderness promator teres & FCR tendons

26
Q

How to people get olecranon bursitis?

A

Repetitive flexion extension movements elbow -> irritation bursa
Less common gout, RA

Rarely fluid infected skin abrasion or
Puncture (S.aureus)

27
Q

Features of olecranon bursitis & investigations

A 
Pain 
Swelling 
Range motion preserved
Infected - systemic 
Examine contralateral

Routine bloods (FBC, CRP)
Rheumatologist causes - specialised tests
Serum urate - gout

Plain film radiograph rule out bony injury

Aspiration fluid - infection/ crystals ✅

28
Q

Management of olecranon Bursitis

A

Dependent if infected - IV antibiotics, surgical drainage
Prolonged - bursectomy

Analgesia
Rest
Splinting elbow
Large - washout

Orthopaedics (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions