Y5 - Elbow: fracture (coronoid, olecranon, radial head) Flashcards
what are coronoid fractures indicative of
an episode of elbow instabiltiy
what can coronoid fractures be associated with
elbow dislocation
what is the mechanism for how a coronoid fracture occurs
a traumatic shear injury
- the distal humerus is driven against the coronoid with an episode varus stress or posterior subluxation
is a coronoid fracture an avulsion fracture
no
why can a coronoid fracture amplify elbow instability
the anterior bundle of the medial collateral ligament attaches to the sublime tubercle distal to the tip
and the anterior capsule attaches distal to the tip of the coronoid
what is the terrible triad of elbow fracture dislocation
an elbow dislocation associated with radial head fracture and coronoid fracture
epi
10% of elbow injuries
what is posteromedial rotatory instability
coronoid anteromedial facet fracture, LCL injury
what is posterolateral rotatory instability
coronoid tip fracture, radial head fracture, LCL injury
what is olecranon fracture-dislocation associated withq
a large coronoid fracture
what is the medial facet of the coronoid important for
varus stability
what does the medial facet of the coronoid do
provides insertion for the medial ulnar collateral ligament
what is the coronoid important for
preventing posterior subluxation
what classification is used for coronoid fractures
regan and morrey classification
what are the three types of regan and morrey classification
type 1 coronoid process tip fracture
type 2 fracture of 50% or less
type 3 fracture of 50% or more
presentation of coronoid fracture
elbow deformity, pain, swelling
physical exam of a coronoid fracture
varus or valgus deformity
ecchymosis & swelling
tenderness
crepitus
investigations
Xray
what view on a xray would be useful for elbow fractures
AP and lateral elbow
management for non-operative fractures
period of immobilisation
followed by reintroduction into range of motion
what are the indications for non-operative fractures
all types of the regan and morrey classification with a minimally displaced stable elbow
what are the different types of olecranon fracture
1 isolated undisplaced/stable fracture
2 displaced/unstable fracture
management for an isolated undisplaced or stable olecranon fracture
immobilisation at above-elbow at 90 degrees elbow flexion
management for a displaced or unstable olecranon fracture
place arm in above-elbow backslab at 90 degrees elbow flexion and refer to ortho
what do most displaced or unstable olecranon fractures require
reduction/fixation
how are olecranon fractures classified
anatomical location
fracture pattern
displacement
what different anatomical locations are common in olecranon fractures
metaphyseal
physeal
epiphyseal
what are the different fracture patterns for olecranon fractures
transverse
oblique
longitudinal
when is deformity associated with olecranon fracture
with radial head dislocation
what investigations are ordered for potential olecranon fracture
AP and lateral view of the elbow
what must the AP view of the elbow in a potential olecranon fracture show
the relationship of the proximal radius and the ulna to the humerus
what % of olecranon fractures require reduction
20%
what is the olecranon part of
the ulna
when may an olecranon fracture occur
a fall onto the outstretched arm
intense contraction of the triceps tendon
what is the mayo classification of olecranon fractures based upon
the stability, the displacement, and the comminution of the fracture
what are the different types of olecranon fracture for the mayo classification
T1 non-displaced fracture
T2 displaced stable fracture
T3 displaced unstable fracture
what is a T2 displaced stable fracture
fracture fragment is displaced more than 3mm but ligaments are intact
what is a T3 displaced unstable fracture
displaced fracture fragment with damaged ligaments
what are the different subtypes of mayo olecranon fractures
non-comminuted
comminuted (lots of fragements)
who are olecranon fractures common in
adults due to its exposed position
rare in children
what nerve may be damaged with an olecranon fracture
olecranon forms part of the ulna, therefore may cause ulnar injury
(numbness and tingling in the 4th and 5th fingers)
management for nondisplaced olecranon fracture
immobilisation with a posterior splint with limited flexion
management for a displaced olecranon fracture
surgically
e.g. tension band fixation
what is the most common cause of a radial head fracture
an outstretched arm
management of a radial head fracture
nondisplaced/stable is supportive casting
displaced/unstable is possible surgery
epidemiology of radial head fractures
women>men
30-40yrs
what are the most common elbow fractures
radial head fractures
what is the mechanism of injury of a radial head fracture
fall onto an outstretched arm
elbow extension and forearm pronation
what injuries are associated with a radial head fracture
ligament injury (lateral collateral ligament) Essex-Lopresti injury
what is a essex-lopresti injury
a distal radioulnar joint injury
what classification system is used for radial head fractures
mason classification
what are the 4 different types of mason classification for radial head fractures
type I - nondisplaced or minimally displaced
type 2 displaced >2mm
type 3 comminuted and displaced
type 4 radial head fracture
what does the lateral pivot shift test
lateral ulnar colateral ligament
what does the valgus stress test
medial collateral ligament
