Elbow Injuries

Elbow Injuries is a topic covered in the 5-Minute Emergency Consult.

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Bony Injuries
  • 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

Soft Tissue Injuries
  • Elbow dislocation:
    • 2nd only to shoulder as most dislocated joint
    • Most are posterior.
  • 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


  • 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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