Elbow Injuries

Description

• Supracondylar fracture:
  • Most common in children
  • Peak ages 5–10 yr, rarely occurs >15 yr
  • Extension type (98%): Fall on outstretched hand (FOOSH) with fully extended or hyperextended arm:
    • Type 1: Minimal or no displacement
    • Type 2: Slightly displaced fracture; posterior cortex intact
    • Type 3: Totally displaced fracture; posterior cortex broken
  • Flexion type: Blow directly to flexed elbow:
    • Type 1: Minimal or no displacement
    • Type 2: Slightly displaced fracture; anterior cortex intact
    • Type 3: Totally displaced fracture; anterior cortex broken
• Radial head fracture:
  • Usually indirect mechanism (e.g., FOOSH)
  • Radial head driven into capitellum
• Ulnar coronoid process fracture:
  • Provides critical stability to elbow as part of ulnohumeral joint
  • Fractures result in instability
  • Most commonly occur in association with other injuries such as elbow dislocations
• The terrible triad:
  • Radial head fracture, coronoid process fracture, and elbow dislocation
  • Difficult to treat and has generally poor outcomes

• Elbow dislocation:
  • Second only to shoulder as most dislocated joint
  • Most are posterior (90%)
• Medial/lateral epicondylitis:
  • Overuse injuries usually related to rotary motion at elbow
  • Involving attachment points of hand and wrist flexor/extensor groups to elbow
  • Plumbers, carpenters, tennis players, golfers
  • Pain made worse by resisted contraction of particular muscle groups

• Subluxed radial head (nursemaid's elbow)
• 20% of all upper extremity injuries in children
• Peak age 1–4 yr; occurs more frequently in females than males
• Sudden longitudinal pull on forearm with forearm pronated

Etiology

• Mechanism aids in determining expected injury
• Trauma predominates
• Most elbow injuries caused by indirect trauma are transmitted through bones of forearm (e.g., FOOSH)
• Direct blows account for very few fractures or dislocations