As the ELBOW Bends MI Zucker, MD

A dr Z lecture

On Common Injuries of the Elbow and Forearm of ADULTS and KIDS

ANATOMY: Adult AP View

ANATOMY: Adult Lateral View

ANATOMY: Kid AP View

ANATOMY: Kid Lateral View

ANATOMY: Kid Special Lines Anterior Humerus Line Radius-capitellum Line

The Famous FAT PADS Anterior and Posterior Intracapsular and extrasynovial

Anterior FAT Pad It is normal, but only when it’s normal! Sharp, small, hugs bone

Normal Fat Pad

The Posterior FAT Pad It is ALWAYS abnormal!

Abnormal FAT Pads Anterior Fat Pad Posterior Fat Pad

The Injuries

RADIUS HEAD Fractures Very common Can be obvious, but often very subtle or occult Almost always have abnormal fat pads

Radius Head Fractures Most treated very conservatively: 3 weeks in a sling, physical therapy.

Radius Head Fractures A few need surgery The Rule of 3’s If more than: 1/3 of articular surface involved More than 30 degrees angulation More than 3mm depression

Olecrannon Process Fractures Unstable due to triceps muscle traction ORIF

Coronoid Process Ulna Fractures May be isolated -but-

Dislocation May be a subtle clue to a spontaneously or patient-reduced dislocation, with severe ligament instability

Adult Supracondylar Fractures Not subtle, high energy, very unstable ORIF

The KID Elbow CRITOE The appearance of the growth centers

The Big 3 of the KID Elbow Supracondylar fracture Lateral Condyle fracture Medial Epicondyle avulsion (In order of prevalence)

Supracondylar Fractures Fraught with complications: Vascular Nerve Osseous

Lateral Condyle Fractures AP

Medial Epicondyle Avulsion Fractures Little Leaguer’s or Pitcher’s Elbow Acute -or- Subacute (stress)

Medial EPICONDYLE Avulsion Fracture Remember: CRITOE Internal (medial) epicondyle -appears BEFORE- Trochlea

Fractures of the RADIUS and ULNA Shafts Adults and older children: Unstable. ORIF In kids, frequently closed reduction and cast is OK

MONTEGGIA Fracture Proximal ULNAR Shaft Fracture -and- RADIAL Head Dislocation ORIF

GALEAZZI Fracture Distal RADIAL Shaft Fracture -and- Distal ULNAR Dislocation ORIF

Parry Fracture AKA “Nightstick Fracture” Isolated usually nondisplaced ULNA shaft fracture

KID Forearm Fractures Elastic bowing Plastic bowing Greenstick Torus or buckle

Elastic and Plastic Bowing Microfractures

Incomplete or Greenstick Fractures One margin of cortex remains partially intact

Combined Plastic bowing deformity of one bone Greenstick or complete fracture of the other bone

Torus or Buckle Fracture Obvious Subtle

Torus or Buckle Fracture The LATERAL view is very helpful in subtle cases Look for the BUMP

INTENTIONAL INJURY CHILD ABUSE An acute and subacute fracture of the ulna and a dislocation of the radius head

INTENTIONAL INJURY “SELFOGENIC” Paper clips

GOODBYE Copyright 2004 MI Zucker, MD