Elbow injuries - upper limb update from Melbourne Arm Clinic
• ELBOW DISLOCATIONS AND THE ASSOCIATED CONDITIONS:
• 1. PURELY SOFT TISSUE INJURIES
• 2. TERRIBLE TRIADS
• 3. RADIAL HEAD FRACTURES
• I prefer to see every dislocation.
• A lot of the Emergency departments don’t record if the Elbow
is stable or not at the time of enlocation and they are sent off
as “ simple “ elbow dislocations.
• A lot of injuries are missed in the process
• EARLY diagnosis and appropriate investigations by means of x
rays and Ct , rarely MRI are important for treatment
• Treatment involves ligament reconstruction or repair, and
fixation of bony fragments with an aim to start early physical
therapy, and minimize stiffness
Radial head fractures
• Very common
• Generally after a fall on an outstretched hand
• X rays and sometimes CT are required.
• When to refer?
• 1. Displaced fractures
• 2. in conjunction with other injuries such as fractures around
the elbow or soft tissue injuries
• 3. communited fractures
• A lot of the population have simple undisplaced fractures that
can be treated in a sling for 10 days and mobilize as soon as
the swelling and pain settle , which is generally around the 5
• These have predictable and good results
• X rays
• Ct is always helpful to assess joint damage
• Questions to ask on seeing an olecranon fracture:
• Is the fracture displaced on x rays?
• Is there an element of joint depression on the ct?
• Is there any other bony injury , such as radial head fracture in
the same limb?
• An answer of yes to any of the above , points towards surgery
Distal Humerus fractures
• Increasing spectrum of injury
• Severe with relatively poorer outcomes
• X rays and ct always are required
Goals of management
• Fix securely
• Move early
• Minimize the risk of arthritis in the future.
• They do get stiff irrespective of how good the radiological
• A lot of them get ulnar nerve neuritis partly as a result of the
injury and partly due to the surgery
• In the elderly, non salavageable distal humerus fractures can
be treated with an elbow arthroplasty with good results
• What do we do to a patient who had a bad multi ligament
injury to the elbow in the setting of an elbow dislocation, but
was missed in the ED as he was sent home immediately after
the elbow reduction, and now presents to you 3-4 weeks later,
stiff yet unstable?
• Unfortunately , see it from time to time
• A bad result.
• Surgical pathway should still be considered
• Can reconstruct the ligaments not repair them, using
expendable tendons as graft material
• The aim is to move them early again, after stable fixation
• Wont be a good result , in terms of range of motion, but will
certainly do better with surgery than without!