Elbow Injuries
Basics
Description
Bony InjuriesDescription
- 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
Soft Tissue Injuries
- 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
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
Etiology
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
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Citation
Schaider, Jeffrey J., et al., editors. "Elbow Injuries." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307312/all/Elbow_Injuries.
Elbow Injuries. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307312/all/Elbow_Injuries. Accessed December 9, 2024.
Elbow Injuries. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307312/all/Elbow_Injuries
Elbow Injuries [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 09]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307312/all/Elbow_Injuries.
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