B10. Elbow fractures and dislocations

Elbow fractures

Elbow fractures involve fractures of the distal humerus, radial head, and olecranon. These are among the most common fractures in the paediatric population, but also occurs in adults. They may occur due to fall on outstretched arm or direct trauma to elbow. Radial head fractures are classified according to Manson, olecranon according to Mayo, and distal humeral fractures according to AO/ASIF. Extraarticular undislocated fractures are treated conservatively.

Etiology

Radial head fractures occur due to trying to break a fall.

Olecranon fractures occur due to fall on elbow.

Distal humeral fractures are caused by fall on outstretched arm, direct trauma, or fall on elbow.

Classification

Radial head fractures are classified according to the Manson classification. Olecranon fractures are classified according to the Mayo classification. Distal humeral fractures are classified according to the AO/ASIF classification:

• Type A – supracondylar (extraarticular)
• Type B – simple condylar (intraarticular)
• Type C – transcondylar (intraarticular)

Clinical features

Elbow pain, swelling.

Diagnosis and evaluation

X-ray. CT may be necessary before surgery.

Treatment

Radial head fractures are managed conservatively in case of type I fractures, and with ORIF for type II – IV.

Olecranon fractures are treated conservatively in case of type I fractures, and with ORIF for type II and III.

Type A distal humeral fractures are managed with functional reduction followed by and cast or ORIF. Type B and C distal humeral fractures are managed with anatomical reduction followed by cast or ORIF.

Elbow dislocations

Elbow dislocations are a relatively common sports injury of the young, and occur due to direct trauma or fall on outstretched hand. Treatment is closed reduction under anaesthesia and immobilisation with cast.

Etiology

Posterior dislocations occur due to fall on outstretched arm, while anterior dislocations occur due to direct trauma with a flexed elbow.

Classification

Elbow dislocations are classified as posterior (most common) or anterior.

Clinical features

Patients usually guard the affected elbow. There may be swelling, deformity, and elastic rigidity.

Diagnosis and evaluation

X-ray should be taken before and after reduction. We must look for associated fractures of the elbow as well, including fractures of the coronoid process and medial or lateral epicondyle.

Treatment

Treatment is closed reduction under anaesthesia, followed by immobilisation with cast.