1. Fracture neck of the radius

2. 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 .

6. 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 .

7. 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 .

8. Pulled elbow

9. Reduction of annular ligament pulled elbow

10. Fracture capitulum

11. 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 .

12. 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 .

13. Fracture capitulum

14. Fracture head of radius

15. 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 .

17. Radial head fracture

18. Complication : 1- joint stiffness .
Treatment : undisplaced fracture : type 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 .

19. Fracture olecranon

20. 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 .

22. Olecranon fracture and its fixation

23. 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 .

24. 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 .

25. Dislocation of the elbow

26. 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.

27. 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 .

29. 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 .

30. Reduction of elbow dislocation

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