Upper limb: Elbow fractures and dislocation

Question 1

what different types of fractures can occur at the elbow

Answer 1

intra-articular distal humerus fracture, olecranon fracture, radial head+neck fracture

Question 2

what are the different types of dislocation that can occur at the elbow

Answer 2

elbow dislocation or fracture dislocation

Question 3

what treatment is required for intra-articular distal humerus fractures

Answer 3

open reduction, internal fixation(ORIF) with anatomic reduction and rigid fixation

Question 4

why is rigid fixation required for intra-articular fractures

Answer 4

in order to minimise loss of function

Question 5

when may elbow replacements be considered for intra-articular distal humerus fractures

Answer 5

in highly comminuted fractures in the elderly

Question 6

describe how olecranon fractures usually occur

Answer 6

with a fall onto the point of the elbow and contraction of the triceps muscle

Question 7

how are the majority if olecranon fractures treated

Answer 7

with internal fixation(ORIF) to restore triceps function and restore articular surface

Question 8

describe how radial head and neck fracturs usually occur

Answer 8

due to fall on to an outstretched arm

Question 9

describe how some undisplaced radial head and neck fractures may present on an X-ray, and can easily be missed

Answer 9

fat pad sign on lateral X-ray, appears as a dark triangle like a sail anterior to distal humerus)

Question 10

describe the pain felt in radial head and neck fractures

Answer 10

lateral elbow pain on supination and pronation

Question 11

how are undisplaced or minimally radial head and neck fractures treated

Answer 11

conservatively with sling, followed by early elbow exercises to minimise stiffness

Question 12

what movement do patients often lose due to radial head and neck fractures

Answer 12

10-15 degrees of terminal extension

Question 13

when may a displaced radial head fracture require surgical management

Answer 13

if displaced fragments cause mechanical block to full extension
internal fixation(ORIF) if fragment large enough

Question 14

in what direction do most elbow dislocations occur and due to what mechanism

Answer 14

posterior direction after fall onto outstretched hand

Question 15

describe the treatment for uncomplicated elbow dislocations

Answer 15

closed reduction under sedation, assessing neurovascular before and after, then 1-3 weeks sling and then physio

Question 16

what associated fractures may occur with an elbow fracture

Answer 16

radial head, humeral epicondyles or coronoid process of the ulna