Elbow Injuries

Basics

Description

Bony Injuries

  • Radial head fractures, coronoid process fractures, olecranon fractures, distal humerus fractures
  • Monteggia and Galeazzi covered separately in forearm fractures
  • 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 (eg, 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

Soft Tissue Injuries

  • Distal biceps and triceps tendon rupture
    • Less common than proximal ruptures
    • Typically men in 4th decade onward
  • Elbow dislocation:
    • 2nd 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

Pediatric Considerations

  • 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
  • More often left arm due to high prevalence of right-hand dominance in caregivers grabbing child’s left hand
  • Recurrence occurs in about 25%

Etiology

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

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