Fracture neck of the radiusFracture neck of the radius

It occur due to fall on out stretched handsIt occur due to fall on out stretched hands. .

In children usually it occur in the neck while In children usually it occur in the neck while in adult it occur in the head of the radiusin adult it occur in the head of the radius. .

ClinicallyClinically: :

Pain and localized tenderness on the head Pain and localized tenderness on the head of the radius and pain on rotating the of the radius and pain on rotating the

forearmforearm. .

treatmenttreatment

Children up to 30` of radial head tilt and up to 3mm Children up to 30` of radial head tilt and up to 3mm of transverse displacement is acceptable , and it of transverse displacement is acceptable , and it

treated by back slab with flexed elbow 90treated by back slab with flexed elbow 90. `. `

Displaced fracture more than this limit need Displaced fracture more than this limit need manipulation under anesthesia , if failed then manipulation under anesthesia , if failed then

open reduction and fixationopen reduction and fixation. .

Radial head should never excised in children , Radial head should never excised in children , although it is one of the ways of the treatment of although it is one of the ways of the treatment of

comminuted fracture of radial head in adultcomminuted fracture of radial head in adult. .

Pulled elbowPulled elbowIn children the elbow may injured by pulling on the arm , it In children the elbow may injured by pulling on the arm , it

called subluxation of the radial headcalled subluxation of the radial head. . It is really subluxation of the orbicular ligament which slip It is really subluxation of the orbicular ligament which slip up over the radial headup over the radial headClinicallyClinically: :

The child is 2-3 years old is presented with painful elbow . The child is 2-3 years old is presented with painful elbow . The history is that the child being jerked by the arm and The history is that the child being jerked by the arm and

crying out in paincrying out in pain. . On examination : the forearm is held in pronation and On examination : the forearm is held in pronation and

extension and resist any supinationextension and resist any supination. . X-rayX-ray : normal : normal. .

TreatmentTreatment : dramatic cure is achieved by forceful : dramatic cure is achieved by forceful supination and then flexing the elbowsupination and then flexing the elbow. .

Pulled elbowPulled elbow

Reduction of annular ligamentReduction of annular ligamentpulled elbowpulled elbow

Fracture capitulumFracture capitulum

This is an articular fracture occur in adultThis is an articular fracture occur in adult . .

The patient fall on the hands with the elbow The patient fall on the hands with the elbow straight . The capitulum or the anterior part straight . The capitulum or the anterior part of it only is sheared off and displaced of it only is sheared off and displaced

proximallyproximally. .

ClinicallyClinically: :

Fullness in front of the elbow , flexion is Fullness in front of the elbow , flexion is completely restrictedcompletely restricted. .

x-rayx-ray :in lateral view the capitulum or part :in lateral view the capitulum or part of it is seen in front of the lower of it is seen in front of the lower

part of the humerus part of the humerus . .

TreatmentTreatment: :

Simple nondisplaced fracture treated by Simple nondisplaced fracture treated by splintage for 2 weeks . Displaced fracture splintage for 2 weeks . Displaced fracture should be treated by open reduction and should be treated by open reduction and

fixationfixation . .

Fracture capitulumFracture capitulum

Fracture head of radiusFracture head of radius

It is occur due to fall on out stretched hands with It is occur due to fall on out stretched hands with elbow extended ; it is common fracture in adult . elbow extended ; it is common fracture in adult .

It is of It is of 3 types3 types: : 11 - -type onetype one : vertical split in radial head : vertical split in radial head. .

22--type twotype two : single fragment in the lateral : single fragment in the lateral portion is broken portion is broken. .

33 - -type threetype three : comminuted fracture : comminuted fracture. .

ClinicallyClinically : swelling at the elbow , marked : swelling at the elbow , marked tenderness at site , sever pain on tenderness at site , sever pain on

pronation and supinationpronation and supination. .

Radial head fractureRadial head fracture

TreatmentTreatment : undisplaced fracture : : undisplaced fracture : type 1type 1 treated by back slab above elbow for 3 treated by back slab above elbow for 3

weeksweeks. . Type 2Type 2 : if the piece is undisplaced then the : if the piece is undisplaced then the treatment is like type one ; if the piece is big and treatment is like type one ; if the piece is big and displaced then it should be reduced and fixated displaced then it should be reduced and fixated

by screw or wireby screw or wire. . Type 3Type 3 treatment by excision of the head of the treatment by excision of the head of the

radius and some time replace it by prosthesisradius and some time replace it by prosthesis. .

ComplicationComplication : 1- joint stiffness : 1- joint stiffness . . 22 - -myositis ossificansmyositis ossificans. .

Fracture olecranonFracture olecranon

22 typestypes: :

11 - -comminuted fracturecomminuted fracture. .

22 - -transverse fracturetransverse fracture. .

This fracture is due to direct blow while the triceps This fracture is due to direct blow while the triceps muscle is contractedmuscle is contracted. .

ClinicallyClinically : in this fracture usually there will : in this fracture usually there will be bruises over the elbow and be bruises over the elbow and swelling ; some time we feel a gape in case of swelling ; some time we feel a gape in case of

transverse fracturetransverse fracture. .

Olecranon fracture and its fixationOlecranon fracture and its fixation

TreatmentTreatment: :

In case of comminuted fracture with triceps apponeorosis is In case of comminuted fracture with triceps apponeorosis is intact , the treatment is by back slab for 3 weeks then intact , the treatment is by back slab for 3 weeks then simple active movement is encouraged to avoid stiffness simple active movement is encouraged to avoid stiffness ,if the fracture is transverse and undisplaced , the ,if the fracture is transverse and undisplaced , the treatment will be by back slab the elbow is in flexion 60` 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 for one week then full p.o.p. for another 3 weeks then

exerciseexercise. . For displaced transverse fracture it need internal fixation For displaced transverse fracture it need internal fixation because it reduced only when the elbow is extended and because it reduced only when the elbow is extended and

stiffness of the elbow in that position is disastrousstiffness of the elbow in that position is disastrous. . The fixation is by tension band wire or by screwsThe fixation is by tension band wire or by screws . .

ComplicationComplication : :

LateLate: :

11 - -stiffness of the elbowstiffness of the elbow. .

22 - -non unionnon union . It is occur after inadequate . It is occur after inadequate reduction and fixation of transverse reduction and fixation of transverse fracture . It's treatment is by rigid fixation and fracture . It's treatment is by rigid fixation and

bone graftingbone grafting . .

33 - -osteoarthritis of elbow jointosteoarthritis of elbow joint , it occur if the , it occur if the reduction is inadequate reduction is inadequate . .

Dislocation of the elbowDislocation of the elbow

Dislocation of the ulno -humeral joint is Dislocation of the ulno -humeral joint is common ; more so in adult than in childrencommon ; more so in adult than in childrenIn 90% of cases the ulna is displaced In 90% of cases the ulna is displaced

posteriorly or postero -lateralposteriorly or postero -lateral. . It is caused by fall on out stretched hand It is caused by fall on out stretched hand with the elbow in extension . If the with the elbow in extension . If the dislocation is not associated with fracture dislocation is not associated with fracture the reduction of the dislocation will be the reduction of the dislocation will be stable and recurrent dislocation is unlikelystable and recurrent dislocation is unlikely . .

If the dislocation is associated with fracture or tear of the If the dislocation is associated with fracture or tear of the ligaments then the reduction will be unstable and ligaments then the reduction will be unstable and

recurrent dislocation is suspectedrecurrent dislocation is suspected. . Anterior dislocation of the elbow can occur in Anterior dislocation of the elbow can occur in (( side swipeside swipe))

injuryinjury. .

ClinicallyClinically : the patient support his or her : the patient support his or her

forearm with the elbow in slightforearm with the elbow in slight flexion .if the swelling is not so sever , the flexion .if the swelling is not so sever , the

deformity is obvious . The relation of the olecranon to the deformity is obvious . The relation of the olecranon to the epicondyles will be abnormal ; the examination is epicondyles will be abnormal ; the examination is impossible due to sever pain , the hands examined for impossible due to sever pain , the hands examined for

nerve and vascular injuriesnerve and vascular injuries. .

X-rayX-ray : it is done to confirm : it is done to confirm: : 11 - -the presence of the dislocationthe presence of the dislocation. .

22 - -the presence of the associated fracturethe presence of the associated fracture. . TreatmentTreatment: :

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

back slab for 1 week then full p.o.p. for 2-3 weeksback slab for 1 week then full p.o.p. for 2-3 weeks . .

Reduction of elbow dislocationReduction of elbow dislocation

ComplicationComplication: :

EarlyEarly : : 11- vascular injury (brachial artery )- vascular injury (brachial artery ). .

22 - -nerve injury median , ulnar nervesnerve injury median , ulnar nerves..

Late Late : : 11- stiffness . - stiffness . 22- myositis ossificans- myositis ossificans, ,

if this occur then put the joint in if this occur then put the joint in splintage until pain subside then gentile splintage until pain subside then gentile active movement advised with anti – active movement advised with anti –

inflammatory druginflammatory drug. .