This document discusses various types of fractures of the distal humerus. It begins by describing distal humerus fractures in general, including common mechanisms of injury and clinical features. It then discusses specific fracture types - supracondylar, intercondylar, condylar, trochlear, and capitellar - providing details on classification systems, treatment options, and potential complications for each. Measurement techniques for radiographic evaluation and several classification systems used for distal humerus fractures are also summarized.

1. DISTAL HUMERUS
FRACTURES

3. • The carrying angle:

4. Content
• SUPRA CONDYLAR #
• INTER CONDYLAR #
• CONDYLAR #
• TROCHLEA #
• CAPITELLAR #

5. Distal humerus fractures
Mechanism of injury:
• Most low energy injury result from a simple fall in
middle aged & in elderly women in which the elbow
is either struck directly or axially loaded in a fall onto
outstretched hand.
• Motor vehicle and sporting accidents are more
common cause of injury in young individuals.

6. Distal humerus fractures
Clinical features:
• Signs and symptoms vary with degree of swelling and
deformity.
• Bony equilateral triangle in maintained
• Crepitus with range of motion
• Gross instability
• Look for signs for volar compartment syndrome
• Neurovascular evaluation

8. Distal humerus fractures
• “Fat pad sign” representing displacement of adipose
layer overlying the joint capsule in the presence of
effusion and hemarthrosis.

9. Measurements on AP radiograph
1. Radial Neck- Shaft Angle
2. Articular Surface Angle
3. Carrying Angle
4. The Baumann angle
5. Trochlear Notch Angle
6. Articular Surface Assessment

10. Radial Neck- Shaft Angle Articular Surface Angle Carrying Angle

11. Baumann angle Trochlear Notch Angle

12. Articular Surface Assessment
I. Trochlear sulcus
II. Lateral trochlear ridge
III. Trochleocapitellar sulcus (sulcus
between the lateral trochlear
ridge and the capitellum)

13. Measurements on Lateral Radiograph
1. Anterior Humeral- Capitellar Line.
2. Radiocapitellar Alignment.
3. Anterior Angulation of Articular Surface of Distal
Humerus.
4. Olecranon- coronoid angle.
5. Greater Sigmoid Notch Circle

14. Anterior Humeral- Capitellar Line Radiocapitellar Alignment

15. Anterior Angulation of Olecranon- coronoid angle
Articular Surface

16. Measurement technique for greater sigmoid notch angle

17. Distal humerus fractures
• Classification
1. AO/ OTA Classification
2. JUPITER & MEHNE Classification
3. MEHNE & MATTA Classification

18. AO/ OTA Classification
Distal
Humerus #
Extra
Articular #
Partial
Articular #
Complete
Articular #
A
B
C

19. AO/ OTA Classification
Extra Articular #
Avulsion #
Simple #
Multifragmentary
#
A 1
A 2
A 3
A

20. AO/ OTA Classification
A 1. Avusion #
A 1.1. A 1.2.
Lateral Epicondlyar # Medial Epicondylar #

21. AO/ OTA Classification
A 1.3.
Medial Epicondylar #
with Incarcerated in humero – ulnar joint.

22. AO/ OTA Classification
A 2 Simple #
A 2.1. A 2.2. A 2.3.
Oblique Oblique Transverse
Downward Downward
Inward Outward

23. AO/ OTA Classification
A 3 Multiplefragmentary
A 3.1. Wedge # (Intact Wedge)
A 3.2. Wedge # (Multiplefragmentary wedge)

24. AO/ OTA Classification
A 3.3.
Complete Metaphyseal #

25. AO/ OTA Classification
Partial
Articular #
Lateral
Sagittal #
Medial
Sagittal #
Frontal #
B 1
B 2
B 3
B

26. AO/ OTA Classification
B 1. Lateral Sagittal #
B 1.1 B 1.2 B 1.3

27. AO/ OTA Classification
B 2. Medial Sagittal #
B 2.1.
Trans-Trochler
Simple
(via Medial side)
B 2.2.
Trans-Trochler
Simple
(via Groove)
B 2.3.
Trans-Trochler
Multifragmentary

28. AO/ OTA Classification
B 3. Frontal #
B 3.1. B 3.2. B 3.3.
Capitellum Trochlea Capitellum
& Trochlea

29. AO/ OTA Classification
Complet
Articular #
Simple #
Metaphyseal
comminution #
Multifragmentary
#
C1
C 2
C 3
C

30. Mehne & Matta Classification
Describe complex bicolumnar distal humerus fractures.

31. Jupiter & Mehne Classification
Based on the “two coloum” and “tie –arch” concept of
elbow stability.

32. General treatment principles:
• Anatomical articular reduction
• Stable internal fixation of articular surface.
• Restoration of articular axial alignment.
• Early range of elbow motion.

33. Treatment options for the various types of humeral #:
• Epicondylar avulsion # (Type A1) with minimal (<1
cm) displacment can be treated conservatively
• Single column # without comminution (Type B1-B3)
can be treated conservatively at first but will likely
require surgery.
• Comminuted or two column # (Type A2, A3, and C1-
3 ) require surgery.

34. Conservative management:
• Nonsurgical treatment may be recommended for
stable fractures in which the pieces of bone are not
out of place (displaced).
• It may also be recommended for patients who are at
higher risk for surgical complications.
1. Cast or splint stabilization
2. Traction
3. Bag of bones technique

35. • Cast or splint stabilization:
Splints are typically worn for 6 weeks before
supervised motion is started. If the fracture shifts out
of position during this time, you may need surgery to
put the bones back together.

36. Surgical intervention
Indications:
1. Significantly displaced fracture
2. Vascular injury
3. Open fracture
4. Inability to maintain acceptable reduction

37. Surgical approach:
1. Lateral column fractures addressed with kocher
approach
2. Medial column fractures are apporached with
posterior triceps reflecting or transolecranon
approach.
3. Bicolumn fractures of distal humerus are operated
with olecranon osteotomy, triceps-splitting or Triceps
Reflecting Anconeus Pedicle approach.

38. Internal fixation:
• Use of two orthogonal plates is the most
stable method of treating these fractures.
• 90-90* with medial and posterolateral
position.
• Medial and lateral position.

46. External fixation:
• External fixation with ring or hybrid ring fixators

47. Total elbow arthroplasty
• Semiconstrained hinge design is used to treat
unsalvageable nonunions.
• All the previous implants are removed and
arthroplasty is proceeded.

49. COMPLICATIONS
1. Volkmann ischemic contracture.
2. Loss of elbow range of motion.
a. Loss of motion due to joint stiffness.
b. Loss of extension dueto callus formation in
olecuranon fossa.
c. Loss of flexion due to capsular contracture.
3. Heterotopic bone formation may occur.

50. CLINICAL FEATURES
SC fracture Humerus Post Dislocation
1. Younger children 1. Slightly older
2. Arm is short 2. Forearm is short
3. Bony triangle maintained 3. Triangle is disrupted
4. Swelling is more 4. Swelling is less
5. Crepitus is present 5. Crepitus is absent
6. Olecranonbelow
intercondylar line
6. Olecranonabove
intercondylar line
7. Step sign negative 7. Step sign positive
8. Restricted movements 8. Grossly restricted
9. Radial nerve affected 9. Median & ulnar N injured

51. INTER CONDYLAR #
• This is most common distal humeral #.
• Comminution is common.
• Mechanism of injury:
Force is directed against the posterior aspect of an
elbow flexed >90 degrees, thus driving the ulna into
the trochlea.

52. INTER CONDYLAR #
Riseborough and Radin classification

53. INTER CONDYLAR #
Nonoperative Treatment
• Indication:
1. Non displaced #,
2. Elderly patient with displaced #
3. Sever osteopenia
4. Comminution
5. Patient with significant comorbid condition
• Cast immobilization
• Bag of bones

54. INTER CONDYLAR #
Operative Treatment
• ORTF with interfragment screws/ Dual plate fixation.
Indication: Displaced reconstructible #
• Total elbow arthroplasty
Indication: a) Markedly communited #
b) Fractures in Osteoporotic bone.
Post operative care: Early range of motion of elbow is
essential unless fixation is tenuous.

55. INTER CONDYLAR #

56. INTER CONDYLAR #
Complications:
1. Post traumatic arthritis
2. Failure fixation
3. Loss of motion
4. Heterotopic bone
5. Neurological injury (upto 15%)
6. Nonunion (5 to 15%)
7. Infection

57. CONDYLAR #
• Rare in adults and much more common in the
pediatric age group.
• Less than 5% of all distal humerus #
• Lateral # more common than medial.
• Mechanism of injury:
Abduction/ Adduction of forearm with elbow
extension.

58. CONDYLAR # - CLASSIFICATION
1. Milch classification of lateral condylar #
2. Milch classification of medial condylar #

59. Milch classification

60. Milch classification

61. CONDYLAR #
Aim: Anatomic restoration of articular congruity is
essential to maintain the normal elbow arc of
motion & to minimize risk of posttraumatic.
Nonoperative treatment:
• Posterior splinting with elbow flexed to 90 degrees
and forearm in supination (lateral condylar #) or
pronation (medial condylar #)

62. CONDYLAR #
Operative treatment:
• Indicated for open or displaced #
• Internal fixation with screws along with or without
collateral ligament repair if necessary.

64. Complications:
• Stiffness
– most common complication
• Nonunion
• AVN
– occurs 1-3 years after fracture
– posterior dissection can result in lateral condyle
osteonecrosis (may also occur in the trochlea)
• Tardy ulnar nerve palsy
– slow, progressive ulnar nerve palsy caused by stretch in
cubitus valgus
– usually late finding, presenting many years after initial
fracture

65. • Malunion
– caused from delay in diagnosis and improper treatment
– 20% cubitus varus in nondisplaced/minimally displaced fractures
• traumatic inflammation leads to lateral overgrowth (see
spurring below)
– 10% cubitus valgus ± tardy ulnar nerve palsy
• because of lateral physeal arrest as fracture is Salter Harris IV
– fishtail deformity
• area between medial ossification center and lateral condyle
ossification center resorbs or fails to develop
• does NOT predispose to arthritis
• may predispose to further fracture
– treatment
• supracondylar osteotomy

66. CAPITELLAR #
• 1% of elbow fractures
• 6% of all distal humerus fractures
• Occur in the coronal plane, parallel to the anterior
humerus.
• Anterior displacement of the articular fragment into
the coronoid or radial fossae may result in a block to
flexion.

67. Mechanism of injury:
• Fall on outstretched arm (typically fall from standing)
• Typically, elbow is in semi-flexed elbow position
• Force is transmitted through radial head to
capitellum. # occur secondary to shear.

68. • Symptoms
– elbow pain, deformity, swelling
• Physical exam
– Inspection and Palpation
• Ecchymosis, swelling
• Diffuse tenderness
– Range of motion & Instability
• May have mechanical block to
flexion/extension and/or rotation
– Neurovascular exam

70. CAPITELLAR #
Bryan and Morrey classification

71. Bryan and Morrey classification
Type 1 : (Hahn – Steinthal fragment)
Large osseous component of capitellum, sometimes
with trochlear involvement.

72. Bryan and Morrey classification
Type 2: (Kocher – Lorenz fragment)
Articular cartilage with minimal subchondral bone
attachment.
“Uncapping of the condyle”

73. Bryan and Morrey classification
Type 3: (Morrey)
Markedly comminuted

74. Bryan and Morrey classification
• Type 4: (McKee)
Extension into trochlea

75. CAPITELLAR #
Nonoperative treatment:
• Posterior splint immobilization for < 3 weeks
– indications
• Nondisplaced Type I fractures (<2 mm
displacement)
• Nondisplaced Type II fractures (<2 mm
displacement)

76. CAPITELLAR #
Operative treatment:
1. Open reduction and internal fixation
2. Arthroscopic-assisted ORIF
3. Fragment excision
4. Total elbow arthroplasty

77. CAPITELLAR #
A. Open reduction and internal fixation
• Indications:
– displaced Type I fractures (<2 mm displacement)
– Type IV fractures
• Technique:
1. ORIF with lateral column approach
2. ORIF with posterior approach with or without
olecranon osteotomy

78. ORIF with lateral column approach
• Indications
– isolated capitellar fractures
– type IV fractures that can have trochlear
involvement
• Approach
– lateral approach recommended for isolated Type I
and Type IV fx

79. • Technique
– Headless screw fixation
– Avoid disruption of the blood supply that comes
from the posterolateral aspect of the elbow
– Do not destabilize LUCL

80. CAPITELLAR #
ORIF with posterior approach with or without
olecranon osteotomy
• Indications
– capitellar fractures with associated
fractures/injuries to distal humuers/olecranon
and/or medial side of the elbow
• Approach
– indicated when more extensive articular work is
needed
– lateral decubitus positioning

81. • Technique
– independent headless compression/cannulated
screws for capitellar component

82. B. Arthroscopic-assisted ORIF
– indications
• isolated type I fractures with good bone stock

83. CAPITELLAR #
C. Fragment excision
– indications
• displaced Type II fractures (<2 mm
displacement)
• displaced Type III fractures (<2 mm
displacement)
D. Total elbow arthroplasty
– indications
• unreconstructable capitellar fractures in elderly
patients with associated medial column
instability .

84. CAPITELLAR #
Complications:
• Elbow contracture/stiffness
(most common)
• Nonunion (1-11% with ORIF)
• Ulnar nerve injury
• Heterotopic ossification
(4% with ORIF)
• AVN of capitellum
• Nonunion of olecranon
osteotomy
• Instability
• Post-traumatic arthritis
• Cubital valgus
• Tardy ulnar nerve palsy
• Infection

85. TROCHLEA #
Laugier’s #
• Extremely rare
• It is associated with elbow dislocation
• Mechanism of injury: Tangential sharing force
resulting from elbow dislocaton.
• Treatment:
Undisplaced # - posterior splinting
Displaced # - ORIF with Kirschner wire or screw
• Complication:
Posttraumatic arthritis; Restricted range of motion

86. RADIAL HEAD #
• 1.5-4% of all fractures
• Most common elbow fractures (33%)
• Radial head fractures can occur in isolation or as part of a
more complex elbow dislocation.
seen in
1. Terrible Triad
(Radial head # dislocation + ULCL + Coronoid process #)
2. Essex-Lopresti injury
(Radial head # dislocation + DRUJ injury + Interosseous
membrane distruption)

87. RADIAL HEAD #
Mechanism of injury:
• Most common is fall onto the outstretched hand.
• Higher energy injuries representing fall from a height
or during sports.
• Elbow in extension + Forearm in pronation, most
force transmitted from wrist to radial head.

88. RADIAL HEAD #
Mason classification

89. RADIAL HEAD #
Clinical evaluation
• Typically present with limited elbow and forearm
motion and pain on passive rotation of the forearm.
• Tenderness over radial head as well as elbow
effusion.
• Stability
1. Elbow
2. DRUJ
3. Interosseous membrane

90. RADIAL HEAD #
• Elbow
– lateral pivot shift test (tests LUCL)
– valgus stress test (tests MCL)
• DRUJ
– palpate wrist for tenderness
• Interosseous membrane
– palpate along interosseous membrane for
tenderness
– radius pull test
• >3mm translation concerning for longitudinal
forearm instability (Essex-Lopresti)

91. RADIAL HEAD #
Imaging
1. Radiographs
• recommended views
– AP and lateral elbow
• check for fat pad sign indicating occult minimally
displaced fracture

92. RADIAL HEAD #
• Additional views
– Radiocapitellar view (Greenspan view)
• oblique lateral view of elbow

93. RADIAL HEAD #
2. CT scan
• further delineate fragments in comminuted fractures
• identify associated injuries in complex fracture
dislocations

94. RADIAL HEAD #
Goal of Treatment
1. Pain free
2. Stable arc of motion
3. Correction of any block to forearm rotation
4. Early range of elbow and forearm motion

95. RADIAL HEAD #
Nonoperative Treatment
• Short period of immobilization followed by early
ROM
– indications
• isolated minimally displaced fractures with no
mechanical blocks (Mason Type I)
– outcomes
• elbow stiffness with prolonged immobilization
• good results in 85% to 95% of patients

96. RADIAL HEAD #
Operative Treatment
1. ORIF
2. Fragment excision (partial excision)
3. Radial head arthroplasty
4. Radial head resection

97. RADIAL HEAD #
Approaches to Radial
Head
A. Kocher approach
(Intervalbetween ECU
& Anconeus)
B. Kaplan approach
(Intervalbetween EDC
& ECRB )

98. RADIAL HEAD #
ORIF
• Indications
– Mason Type II with mechanical block
– Mason Type III where ORIF feasible
– presence of other complex ipsilateral elbow
injuries
• Outcomes
• ORIF shown to have worse outcome with 3 or
more fragments compared to ORIF with < 3
fragments

99. RADIAL HEAD #
• Posterolateral placement
Safe zone (nonarticular area) consists of
90-110 degree arc from radial styloid to
Lister's tubercle, with arm in neutral
rotation to avoid impingement of ulna
with forearm rotation.

100. RADIAL HEAD #
Mini fragment 1.5 mm or 2.0 mm screws, Mini fragment 1.5 or 2.0 T-plate
Headless compression screws
(Herbert or similar screws)

101. RADIAL HEAD #

103. RADIAL HEAD #

104. RADIAL HEAD #
Radial head resection
• Indications
1. low demand, sedentary patients
2. in a delayed setting for continued pain of an isolated
radial head fracture
• contraindications
1. presence of destabilizing injuries
2. forearm interosseous ligament injury (>3mm
translation with radius pull test)
3. coronoid fracture
4. MCL deficiency

105. RADIAL HEAD #

106. RADIAL HEAD #
Complications after excision of the radial head
include:
1. Muscle weakness
2. Wrist pain
3. Valgus elbow instability
4. Heterotopic ossification
5. Arthritis
6. Proximal radial migration
7. Decreased strength
8. Cubitus valgus

107. RADIAL HEAD #
Replacement arthroplasty
Indication
• Unreconstructable radial head fracture associated with
an unstable fracture of the coronoid process.
• After radial head excision with evidence of medial
collateral ligament insufficiency or ulnohumeral
instability.
• Unreconstructable radial head fracture associated with
interosseous membrane injury.
• Unreconstructable radial head fracture with acute
distal radioulnar joint injury (Essex-Lopresti injury).

108. RADIAL HEAD #
Contraindication
• Simple fracture
• Reconstructable multifragmentary fracture
• Stable elbow

109. Complications
1. Displacement of fracture
2. Posterior interosseous nerve injury (with operative
management)
3. Loss of fixation
4. Loss of forearm rotation
5. Elbow stiffness
6. Radiocapitellar joint arthritis
7. Infection
8. Heterotopic ossification
9. Hardware loosening
10. Complex regional pain syndrome

110. Olecranon Fractures
• Bimodal distribution.
• high energy injuries in young
• secondary to falls in the elderly
• 8% to 10% of all elbow fractures
Mechanismof injury
• Direct blow
• A fall on an outstretched hand with the elbow in flexion
• Sudden and violent triceps muscle contraction can
produce an avulsion fracture of varying size of the
olecranon tip

111. Olecranon Fractures
• Symptoms
– pain well localized to posterior elbow
• Physical exam
– palpable defect
• indicates displaced fracture or severe
comminution
– inability to extend elbow
• indicates discontinuity of triceps (extensor)
mechanism

112. Olecranon Fractures
• Radiographs
– recommended views
• AP/lateral radiographs
–true lateral essential for determination of
fracture pattern
– additional views
• radiocapitellar may be helpful for
–radial head fracture
–capitellar shear fracture

113. Olecranon Fractures Classification
1. Mayo Classification
2. Schatzker Classification
3. Colton Classification
4. AO Classifiation

114. Mayo Classification

115. Schatzker Classification

116. Colton Classification
Type 1 Type 2
Nondisplaced Avulsion (displaced)

117. Colton Classification
Type 3 Type 4
Oblique and Transverse Comminuted
(displaced) (displaced)

118. Colton Classification
Type 5
Fracture dislocation

119. AO Classifiation
Extraarticular Intraarticular Intra-articular #
of both the radial
head and olecranon
Olecranon #
Type A Type B Type C

120. AO Classifiation
Type A
Extraarticular
A1.1 A1.2 A1.3
Avulsion # Simple metaphyseal # Multifragmentary
metaphyseal #

121. AO Classifiation
Type B
Intraarticular
B1.1 B1.2 B1.3
Unifocal # Simple, Multifragmentary,
(olecranon/coronoid) Bifocal # Bifocal #

122. AO Classifiation
Type C
Intra-articular # of both the radial head and olecranon

123. Olecranon Fractures
Nonoperative Treatment
• Immobilization
– Indications
• nondisplaced fractures
• displaced fracture is low demand, elderly
individuals
– Technique
• immobilization in 45-90 degrees of flexion
initially

124. Olecranon Fractures
Operative Treatment
1. Tension band technique
2. Intramedullary fixation
3. Plate and screw fixation
4. Excision and triceps advancement

125. Olecranon Fractures
Tension band technique
Indication:
• Transverse fracture with no comminution.
Contraindication
• Oblique or multifragmentary fracture of the
olecranon
Posterior approach

126. Olecranon Fractures
Technique:
• Converts distraction force of triceps into a compressive
force
• Avoid overpenetration of wires through anterior cortex
– may injury anterior interosseous nerve (AIN)
– may lead to decreased forearm rotation

127. Tension band technique

128. Olecranon Fractures
Intramedullary fixation
Indications
• transverse fracture with no comminution
Technique
• can be combined with tension banding
• intramedullary screw must engage distal intramedullary canal
• Introduce a 6.5 mm cancellous screw with a 32 mm thread
and a washer inside the canal. The screw should cross the
fracture site at least 7cm.

129. Olecranon Fractures
Plate and screw fixation
1. Lag screw protection plate fixation
2. Tension band plate fixation
3. Bridging plate fixation

130. Olecranon Fractures
1. Lag screw protection plate
Indication
• Intraarticular oblique fracture of the olecranon
Contraindication
• Multifragmentary #
• Simple transverse #

131. Olecranon Fractures
2. Tension band plate
Indication
• Multifragmentary olecranon
fracture in which articular
surface is intact
• More distal olecranon
fractures
Contraindication
• Multifragmentation of the
articular surface

132. Olecranon Fractures
3. Bridging plate
Indication
• Multifragmentary articular fragmentation of the ulna
Contraindication
• Simple fracture
• Bony buttress in the joint

133. Olecranon Fractures
Excision and triceps advancement
Indications
1. elderly patients with osteoporotic bone
2. fracture must involve <50% of joint surface
3. nonunions
Technique
• Triceps tendon reattached with nonabsorbable
sutures passed through drill holes in proximal ulna

134. Excision and triceps advancement

135. Olecranon Fractures
Complications
• Symptomatic hardware
– most frequent reported complication
• Stiffness
• Heterotopic ossification
• Posttraumatic arthritis
• Nonunion
• Ulnar nerve symptoms
• Anterior interosseous nerve injury
• Loss of extension strength

136. Coronoid Fractures
• Coronoid fractures are pathognomonic of an episode
of elbow instability.
• Occur in 10% to 15% of elbow dislocation
Mechanism
– Traumatic shear injury
• Typically occurs as distal humerus is driven
against coronoid with an episode of severe
varus stress or posterior subluxation.

137. Coronoid Fractures
Regan and Morrey Classification
•Type I
Coronoid process tip #
•Type II
Fracture of 50% or less of height
•Type III
Fracture of more than 50% of height

138. Coronoid Fractures
O'Driscoll Classification

139. Coronoid Fractures
O'Driscoll Classification

140. Coronoid Fractures
Associated conditions
• Posteromedial rotatory instability
– coronoid anteromedial facet fracture and LCL
disruption. Results from a varus deforming force
• Posterolateral rotatory instability
– coronoid tip fracture, radial head fracture, and LCL
injury
• Olecranon fracture-dislocation
– usually associated with a large coronoid fracture
• Terrible triad of elbow
– coronoid fracture (transverse fracture pattern),
radial head fracture, and elbow dislocation

141. Coronoid Fractures
• Radiographs
– recommended views
• AP and lateral elbow views
– findings
• interpretation may be difficult due to
overlapping structures
• CT scan
– Recommended when coronoid # is
suspected

142. Coronoid Fractures
Nonoperative Treatment
• Brief period of immobilization, followed by early
range of motion
• Indications
– Type I, II, and III that are minimally displaced
with stable elbow

143. Coronoid Fractures
Operative treatment
1. Suture repair
2. Fixation with lag screw
3. Fixation with anteromedial plate with or without
additional lag screws
4. Fixation with dual plate fixation

144. Coronoid Fractures
1. Suture repair
• In small type I and II, and multifragmentary, fractures
of the coronoid process, the fragments with joint
capsule can be reattached with sutures
• This requires a Medial approach.

145. Coronoid Fractures
2. ORIF with lag screw
• In simple fractures where at least 50% of the
coronoid process is involved, the fracture fragment
may be reinserted and held with one or two 2.7 mm
lag screws.

146. Coronoid Fractures
3. ORIF with Plate (contoured three-hole one-third
tubular plate.)
• For larger anteromedial facet coronoid fractures
(O’Driscoll type II), an anteromedial plate with or
without additional lag screws provides good stability

147. Coronoid Fractures
4. ORIF with Dual plate fixation
• Indicated in basilar coronoid fractures, associated
with olecranon fracture dislocations.

148. Coronoid Fractures
Complications:
1. Recurrent elbow instability
– especially medial-sided
2. Elbow stiffness
3. Posttraumatic arthritis
4. Heterotopic ossification

149. Elbow dislocation
Incidence
• Elbow dislocations are the most common major joint
dislocation second to the shoulder
– most common dislocated joint in children
• Account for 11-28% of injuries to the elbow
• Posterolateral is the most common type of
dislocation (80%)
• Predominantly affects patients between age 10-20
years old

150. Mechanism of Injury:
• Most commonly, injury is caused by a fall onto an
outstretched hand or elbow.
• Posterior dislocation : This is combination of elbow
hyperextension, valgus stress, arm abduction, and
forearm supination.
• Anterior dislocation: A direct force strikes the
posterior forearm with elbow in flexed position.

152. • Elbow dislocation with
no associated fracture
• Accounts for 50-60% of
elbow dislocations
• Elbow dislocation with
associated fracture
Elbow
dislocation
Simple Complex

153. Signs and Symptoms
• Varying degrees of pain, swelling, and ecchymosis.
• In many cases, there is also instability, crepitation, and
deformity
• Posterior: elbow is flexed with prominence of
olecranon- on palpation olecranon is displaced from
plane of epicondyles.

154. Signs and Symptoms
• Anterior: elbow held in full extension, upper arm
appears shortened with forearm held in supination
and elongated
• Triangle is disrupted, Olecranonabove intercondylar
line, Step sign positive
• With the elbow flexed at 90 degrees,the medial &
lateral epicondyles & olecranon process should from
isosceles triangle.

155. Signs and Symptoms
• Neurovascular examination
• Most commonly injured vessel: Brachial Artery-
more common with anterior and open dislocations.
• Median and ulnar nerve are most susceptible to
damage

156. • Simple DislocationClosed reduction: correction of
medial or lateral displacement followed by
longitudinal traction and flexion
• Parvin’s method (Method A) :
patient lies prone with entire upper
extremity hanging off the bed,
downward traction is applied to the
wrist for a few minutes—> olecranon
slips distally, arm is then lifted gently

157. • Meyn & Quigley method (Method B) : forearm hangs
off of bed, gentle downward traction is applied to
wrist, olecranon is guided with opposite hand

158. • Assess range of motion after reduction (instability
can be appreciated with elbow extension)
• Immobilize in long arm posterior splint with
elbow in 90 degrees of flexion for 1-2 week with
orthopedics follow up as outpatient within 1
week for repeat radiographs
– A recent multi-center study suggests that early
mobilization may be superior to immobilization with
better functional outcomes at 6 weeks, but
comparable functional outcomes at 1 year
– Prolonged immobiization (>3 weeks) is associated
with poor functional outcomes, pain and contractures

159. Complications
• vascular injury of brachial artery may occur but with a lesser
frequency than in cases of supracondylar fracture .
• nerve injury . the medial ulnar nerve may be affected
.c/myositis ossification ,which is more common if passive
exercise is inflicted on the patient.
• Recurrent of the dislocation may occur if the bony ,
ligamentous, and muscular support structure are disrupted
sufficeintly.
• late complications 1/stiffness 2/heterotopic ossification
3/unreduced dislocation 4/recurrent dislocation
5/osteoarthritis after sever fracture dislocation.

160. Complications
• vascular injury of brachial artery may occur but with a lesser
frequency than in cases of supracondylar fracture .
• nerve injury . the medial ulnar nerve may be affected
.c/myositis ossification ,which is more common if passive
exercise is inflicted on the patient.
• Recurrent of the dislocation may occur if the bony ,
ligamentous, and muscular support structure are disrupted
sufficeintly.
• late complications 1/stiffness 2/heterotopic ossification
3/unreduced dislocation 4/recurrent dislocation
5/osteoarthritis after sever fracture dislocation.

161. THANK YOU