Fractures and Dislocations of the Elbow/Forearm Unit Three Lesson Four

BELLWORK “Before & After” Using a piece of notebook paper, answer the following questions, leaving a line between each answer. Put the paper aside until the end of class. 1. How do you get an arm fracture? 2. How do you get an elbow dislocation? 3. What does an arm fracture look like? 4. What does an elbow dislocation look like?

Objective Differentiate between common injuries and their mechanisms, signs, symptoms and treatments.

Terminology Genetic Hypermobility: a condition in which an individual’s joints can move beyond normal anatomical limits. Intracondylar: the area of a bone that is between two condyles, usually at the distal end of a bone that forms a hinge joint. Supracondylar: the area of a bone that is directly above the condyles, just proximal to the joint.

Terminology Carrying angle: the angle of cubital valgus force created at the humeroulnar joint. This angle allows our arms to swing freely at our sides without hitting our hips. Why do you think females tend to have a bigger carrying angle? Why is it important to check bilaterally when you suspect a fracture?

Elbow Fractures

Epiphyseal Fracture Epiphyseal and/or avulsion fractures of the medial epicondyle or the olecranon process are most common in adolescents Mechanism FOOSH, direct blow Signs & Symptoms Possible deformity, numbness/tingling, pain (severe), TTP at growth plate, loss of ROM, decreased strength, felt or heard a “snap” Treatment Splint & sling immediately! Send for x- ray ASAP. Most likely casted for 4-6 weeks Rehab when appropriate

Epiphyseal and/or avulsion fractures of the medial epicondyle or the olecranon process are most common in adolescents Mechanism Powerful muscular contraction applied to the medial epicondyle or the olecranon process (avulsion fracture) Signs & Symptoms Palpable deformity, numbness/tingling, pain (severe), loss of ROM, decreased strength, most likely heard/felt a “snap” Treatment Splint & sling immediately! Send for x- ray ASAP. Most likely casted for 4-6 weeks after surgical repair Rehab when appropriate Avulsion Fracture

Supracondylar fracture Supracondylar fractures of the humerus are not common but occasionally occur in contact sports Mechanism Powerful valgus or varus force with the elbow locked in a fully extended position (supracondylar fracture) Extreme hyperextension force (supracondylar fracture) Signs & Symptoms Possible deformity, numbness/tingling, pain (severe), loss of ROM, decreased strength, heard or felt a “snap” Treatment Splint & sling immediately! Send for x- ray ASAP. Most likely casted for 4-6 weeks Rehab when appropriate Supracondylar fracture

Intercondylar fracture Intercondylar fractures of the humerus are rare Mechanism Direct impact (intracondylar fracture), FOOSH Signs & Symptoms Possible deformity, numbness/tingling, pain (severe), loss of ROM, decreased strength Treatment Splint & sling immediately! Send for x- ray ASAP. Most likely casted for 4-6 weeks Rehab when appropriate

Proximal radius and ulna Other fractures associated with the elbow include the proximal radius and ulna, olecranon process, or the distal humerus

Elbow Fracture Signs/ Symptoms Point tenderness over the medial epicondyle or olecranon process in cases of epiphyseal or avulsion fracture Obvious deformity (especially present with supracondylar fractures) Pain 2 inches above the elbow joint on the medial aspect (high suspicion for intercondylar fracture)

Forearm Fractures

Forearm Fractures Very common in youth sports injury Often involves both the radius and ulna When both-bone forearm fractures are located at the distal forearm near the wrist they are termed Colles’ fractures

Forearm Fracture Mechanisms Fall on the outstretched hand (Colles’ Fracture) Fall on the back of the outstretched hand (Reverse Colles’ Fracture) Direct Blow

Forearm Fracture Signs/Symptoms Athlete reports feeling a “pop” or “snap” Obvious Deformity (false joint) Pain Swelling Crepitus

Forearm Fracture Treatment RICE Splint Sling MD Referral

Elbow Dislocations

Elbow Dislocations Ulna is dislodged from the humerus Most often ulna moves posteriorly Somewhat common injury, especially in contact/collision sports

Elbow Dislocation Etiology Violent hyperextension force Severe blow to the lateral aspect of the elbow while weight is being supported on the hand Genetic Hypermobility

Elbow Dislocation Signs/Symptoms OBVIOUS DEFORMITY!!! Severe Pain Loss of Function

Elbow Dislocation Treatment Treat as a medical emergency!!! Splint arm/elbow in the position it is found in Check distal pulses and sensation for vascular and/or nerve impairment

“What’s My Injury?” With a partner, choose an injury from today’s lesson Write a creative scenario about that injury including the etiology, pathology, and treatment for the injury Be prepared to share with the class

“Before & After” CLOSURE On your Before and After bellwork sheet, answer the following questions on the line below your “Before” answers. This will assess your new learning for the day! 1. How do you get an arm fracture? 2. How do you get an elbow dislocation? 3. What does an arm fracture look like? 4. What does an elbow dislocation look like?