This document discusses the treatment options for fractures of the elbow. For undisplaced fractures, immobilization in a plaster cast is recommended. For displaced fractures, options include closed or open reduction with K-wire fixation or traction. Traction techniques are described to gradually extend the elbow. Complications of elbow fractures include injury to the brachial artery or nerves, Volkmann's ischemia, malunion, myositis ossificans, and Volkmann's contracture. Specific treatments are outlined for these complications.

1. J.B.S.Nandita Jyothi
Roll no.77

2. • For undisplaced fracture- immobilized in an above
elbow plaster slab with the elbow 90° in flexion

3. For displaced fractures:
closed reduction and percutaneous K wire fixation
or
open reduction and K wire fixation
or
continuous traction are the available options

4. 1) Traction with elbow in flexion
– counter traction applied at arm-
gradual extension of elbow and
suppination of forearm- proximal
and medial-lateral displacements
2) Flexion in traction- thumb on
olecranon- flex elbow while
maintaining traction
3) Pressure over olecranon-
forward into flexion- observe
radial pulse obliteration- extend
and apply slab in the position
That pulse returns

5. When elbow flexed beyond 90° while tracture is being
applied simultaneously while olecranon is pushed into
flexion- there occurs locking- the intact periosteum and
triceps act as internal splint and stabilize reduction

6. Used when it is not possible to achieve a good position by
closed methods or when it gets redisplaced after reduction
Used as first line treatment when exploration of brachial
artery is required to check for injury

8. Immediate complications- occuring at the time of fracture-
injury to brachial artery, injury to nerves
Early complication- wihin 2-3 days- volkmann’s ischemia
Late complication – weeks to months after fracture-
malunion, myositis ossificans, volkmann’s ischemic
contracture

9. • Injury to brachial artery by
proximal fragment –
collaterals maintain blood
flow but supply to flexor
muscles is compromised
leading to volkmann’s
ischemia
• Injury to median and radial
nerve- spontaneous recovery
occurs in most cases

10. Volkmann’s ischemia: ischemic injury to flexor
compartment of forearm- most commonly affected muscles
are flexor pollicis Longus and flexor digitorum profundus
as anterior interosseous artery is an end artery
Signs- severe pain in forearm, pain in flexor aspect of
forearm when fingers are extended
Treatment- remove splint, elevate forearm move fingers, if
no improvement within 2 hours- do urgent decompression
by fasciotomy

11. Malunion – most common complication- when fracture
unites with distal fragment tilted medially and in internal
rotation- results in cubitus varus deformity or gunnstock
deformity
Treatment- range of movement is not restricted usually,
supracondylar corrective osteotomy done in case of severe
deformity

13. Myositis ossificans – ectopic new bone formation in elbow – poor
prognosis
Volkmann’s ischemic contracture- muscles are replaced by fibrous
tissue which contracts and draws wrist and fingers into flexion.
 Clinical features- atrophy of forearm, flexion deformity of wrist and
fingers
 Volkmanns sign- possible to extend fingers at interphalyngeal joint
only when wrist is flexed
 Treatment- passive stretching of muscles using turn buckle splint(
Volkmann’s splint), maxpage operation- flexor muscles released from
attachment at ulna, bone operations- shortening of forearm bones

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