UL:RADIAL AND ULNA FRACTURES

Question 1

SUBLUXATION OF THE RADIAL HEAD

Answer 1

More common in children

SIGNS AND SYMPTOMS

• The X-Ray will appear normal because the radial head is not visible on X-Ray until 3-5 years old.
• The child won’t use the arm and there will be local tenderness over the radial head. Supination will be decreased.

MANAGEMENT
Manipulation and then sling/collar and cuff for a few days.

Question 2

DISLOCATION OF THE ELBOW

Answer 2

More common in adults

CAUSE
Associated with contact sports.

DEFORMITY
The dislocation is usually posterior or posterolateral.

COMPLICATIONS
Neurovascular injury
Joint stiffness and myositis ossificans

MANAGEMENT
-Reduction under anaesthesia followed by immobilisation in an above elbow back-slab with the elbow flexed to 90° for not more than 3/52.
-If the dislocation is only diagnosed between 3 and 8/52 post-injury, the limb is immobilised as above. A late diagnosis after 8/52 may require surgical reduction.
-ASSOCIATED FRACTURES =Fracture of the coronoid process, fracture of the olecranon (anterior dislocation), fracture
of the radial head or avulsion of the medial epicondyle. Usually the associated fracture
is minor and the treatment is directed primarily at the dislocation.

Question 3

FRACTURE OF THE RADIAL HEAD

Answer 3

More common in adults

CAUSE
Fall on the outstretched hand forcing the elbow into valgus causes the radial head
to be crushed against the capitulum.

MANAGEMENT

• Undisplaced fracture=Treated symptomatically. The arm may be rested in a sling and mobilised from about 2/52.
• Comminuted fracture=The radial head is excised and the arm is rested in a sling for about 2/52 before mobilising.

Question 4

FRACTURE OF THE OLECRANON PROCESS

Answer 4

More common in adults

CAUSE
Fall onto the point of the elbow.

MANAGEMENT
-Transverse fracture with minimal separation of the fragments
=Immobilise in a back-slab with the elbow flexed to 90° for 3-6/52. Thereafter start gentle active movement

-Marked separation of fragments
=ORIF using K-wires and tension-band wiring or a cancellous screw. A back-slab may be applied for up to 3/52.

-Severely comminuted fracture
=An open reduction may be performed to resect the fragments and the triceps tendon is then re-attached to the ulnar stump. The arm will be immobilised in a back-slab for up to 3/52.

-Precautions and contra-indications for open reduction
=Avoid antigravity triceps exercise for 4-6/52 (depending on surgeon) as they may loosen ORIF. (Can do Gr 1 and 2 triceps and graded isometrics)

-Physiotherapy guidelines after any fracture at the elbow
Recommended that physiotherapy to improve elbow ROM after back-slab removal
– take care myositis ossificans. Active exercises must be emphasised in the interim.
Early mobility is always a priority. Monitor circulation constantly.
Work to regain flexion and extension. Flexion important for function.
Take care with passive movements of the elbow.
A range of 25° - 120° is usually acceptable in these patients.
Don’t forget pro- and supination, flexion, extension, radial deviation and ulnar deviation of the writs.
CPM is a useful modality – take care myositis ossificans