Fracture neck of the radius

Clinically : It occur due to fall on out stretched hands . In children usually it occur in the neck while in adult it occur in the head of the radius . Clinically : Pain and localized tenderness on the head of the radius and pain on rotating the forearm .

treatment Children up to 30` of radial head tilt and up to 3mm of transverse displacement is acceptable , and it treated by back slab with flexed elbow 90` . Displaced fracture more than this limit need manipulation under anesthesia , if failed then open reduction and fixation . Radial head should never excised in children , although it is one of the ways of the treatment of comminuted fracture of radial head in adult .

Pulled elbow Clinically : In children the elbow may injured by pulling on the arm , it called subluxation of the radial head . It is really subluxation of the orbicular ligament which slip up over the radial head Clinically : The child is 2-3 years old is presented with painful elbow . The history is that the child being jerked by the arm and crying out in pain . On examination : the forearm is held in pronation and extension and resist any supination . X-ray : normal . Treatment : dramatic cure is achieved by forceful supination and then flexing the elbow .

Pulled elbow

Reduction of annular ligament pulled elbow

Fracture capitulum

Clinically : This is an articular fracture occur in adult . The patient fall on the hands with the elbow straight . The capitulum or the anterior part of it only is sheared off and displaced proximally . Clinically : Fullness in front of the elbow , flexion is completely restricted .

x-ray :in lateral view the capitulum or part of it is seen in front of the lower part of the humerus . Treatment : Simple nondisplaced fracture treated by splintage for 2 weeks . Displaced fracture should be treated by open reduction and fixation .

Fracture capitulum

Fracture head of radius

It is occur due to fall on out stretched hands with elbow extended ; it is common fracture in adult . It is of 3 types : 1- type one : vertical split in radial head . 2-type two : single fragment in the lateral portion is broken . 3- type three : comminuted fracture . Clinically : swelling at the elbow , marked tenderness at site , sever pain on pronation and supination .

Radial head fracture

Complication : 1- joint stiffness . Treatment : undisplaced fracture : type 1 treated by back slab above elbow for 3 weeks . Type 2 : if the piece is undisplaced then the treatment is like type one ; if the piece is big and displaced then it should be reduced and fixated by screw or wire . Type 3 treatment by excision of the head of the radius and some time replace it by prosthesis . Complication : 1- joint stiffness . 2- myositis ossificans .

Fracture olecranon

2 types : 1- comminuted fracture . 2- transverse fracture . This fracture is due to direct blow while the triceps muscle is contracted . Clinically : in this fracture usually there will be bruises over the elbow and swelling ; some time we feel a gape in case of transverse fracture .

Olecranon fracture and its fixation

Treatment : In case of comminuted fracture with triceps apponeorosis is intact , the treatment is by back slab for 3 weeks then simple active movement is encouraged to avoid stiffness ,if the fracture is transverse and undisplaced , the treatment will be by back slab the elbow is in flexion 60` for one week then full p.o.p. for another 3 weeks then exercise . For displaced transverse fracture it need internal fixation because it reduced only when the elbow is extended and stiffness of the elbow in that position is disastrous . The fixation is by tension band wire or by screws .

Complication : Late : 1- stiffness of the elbow . 2- non union . It is occur after inadequate reduction and fixation of transverse fracture . It's treatment is by rigid fixation and bone grafting . 3- osteoarthritis of elbow joint , it occur if the reduction is inadequate .

Dislocation of the elbow

Dislocation of the ulno -humeral joint is common ; more so in adult than in children In 90% of cases the ulna is displaced posteriorly or postero -lateral . It is caused by fall on out stretched hand with the elbow in extension . If the dislocation is not associated with fracture the reduction of the dislocation will be stable and recurrent dislocation is unlikely.

Clinically : the patient support his or her If the dislocation is associated with fracture or tear of the ligaments then the reduction will be unstable and recurrent dislocation is suspected . Anterior dislocation of the elbow can occur in ( side swipe) injury . Clinically : the patient support his or her forearm with the elbow in slight flexion .if the swelling is not so sever , the deformity is obvious . The relation of the olecranon to the epicondyles will be abnormal ; the examination is impossible due to sever pain , the hands examined for nerve and vascular injuries .

X-ray : it is done to confirm : 1- the presence of the dislocation . 2- the presence of the associated fracture . Treatment : Uncomplicated dislocation reduction should be done under G.A. with muscle relaxant ; the surgeon pull on forearm while the elbow is slightly flexed , the olecranon pushed by the thumb fore ward , then do gradual flexion of the elbow ; full flexion is can not be obtained unless perfect reduction done ; then checking of the 1- movement of the joint , it's full range . 2- it's stability . 3- distal neurovascular injuries .4- new x-ray to detect the reduction . Immobilization of the joint at 90` flexion in back slab for 1 week then full p.o.p. for 2-3 weeks .

Reduction of elbow dislocation

Complication : Early : 1- vascular injury (brachial artery ) . 2- nerve injury median , ulnar nerves. Late : 1- stiffness . 2- myositis ossificans , if this occur then put the joint in splintage until pain subside then gentile active movement advised with anti – inflammatory drug .