The elbow fracture Taiz University,faculty of medicine and health sciences By Dr : Asma Mahuob

2. Anatomy of the Elbow
Is a synovial hinge joint formed by
articulation between the humerus , radius
and ulna.
TrochlearCapitulum
Head of radius
Trochlear
notch of ulna

4. Elbow joint stability
Due to the shape and fit of bones that make
joint and the surrounding tissue as
capsular and collateral ligaments:
1-radial collateral lig.
2-anular lig. Of radius
3-ulnar collateral lig.4- transverse lig.

5. Muscles
Flexor-pronator muscles attached to medial
epicondyle brachialis biceps brachi
brachioradialis and extensor –supinator muscle
triceps anconeus attached to lateral
epicondyle

7. Nerve
1-Median n
2-radial n
3-ulnar n

9. Physical examination:
Inspection look for:
Swelling , muscle wasting
,scare , edema , laceration ,
deformities , skin change , cubitus
valgus , cubitus verus
Palpation:
Soft tissue , posterior aspect , lateral
aspect , antreior aspect

11. MOVEMENT OF ELBOW
Flexion ( Brachioradialis , biceps(
Extension ( Triceps(
Supination (biceps , supinator(
Pronation ( pronator teres , pronator
quadratus( .

12. Movement of elbow

13. Ossification of the elbow bones
Ossification in menemonic critoe
Capitulum ossified at 2 years of age
The medial epicondyle ossified at 6 years
Trochlea at8 years of age
Olecranon at 10 years of age
Lateral epicondyle at 12 years of age
So we cant detect fractures of this part before this age
but by special technicality such as baumanns angle
which subtended by the longitudinal axis of humerus
shaft and line through the coronal axis of the capitellar
physis it is normal less than 80 degree it is important
to be sure that the distal fragment is reduced.

14. Fracture around the elbow

18. Fracture of the condoyle
Mechanism of injury
High energy injutry except in osteoportic
clincly
pain swelling
check pules

19. Clinical feature
1-elbow is swollen
2-deformed
3-tenderness over the lateral condyle
4-passive flexion of the wrist may be
Painful

20. X-ray
fracture extend from lower humerus to
elbow joint its difficult to tell whether one
or both condyle involved spcialy if it
undisplaced condyler fracture

21. treatment
A- if there is no displacement
The arm can be in a bakslab with elbow
Flexed 90 x-ray to exclud late
displacment gentel movment after
one week
B-displaced fracture
open reduction and internal fixation
throgh postiror approach

22. •Ulner nerve should be identifide and
protacted from injury
•Fregment reduce and held temporary with
k wirs if fracture small fregment
unicondyler and not commented it fixed
with screws
•Large fregment do plate to prevent
displacment
•Bicondyler and commented do double
plate and screws fixation

23. •And somtime bone graft in the gaps
•Postoprtive movment encouraed but not
forced
•Healing in about 8weeks
•In olde pt elbow replacment is more relible
option

24. complication
Vasculer injery
nerve injery usually median and ulner
nerve
staffnes
hetrotopic ossification process form bone
tissue outside skeleton

25. Inter condyler fracture
•T or y shaped fracture
•Mechanism fall into the elbow medial
•And latral condyle sepreted from each
other and rotated downword outword duto
effect of flexor and extensor muscle
l

26. treatment
One of the most difficult to treat
Functional result without
reduction are generaly poor and even when
accurately reduced some residual loss of
function is usuall
Open reduction and internal fixation requir
high dgree of skills its indicated in yonge
adult

27. •Treatment by early activity is suitable in
old pt and function result are satisfactory
•Some surgeons do skeletel traction
through the olecranon as alternative open
reduction Its easier and safer but
functional result not good

28. of medial epicondyle Avulsion
fracture
•Avulsion of epiphysis of medial epi
condyle is common duto strain applid to
elbow with force of flexor group of muscle
•Position of avulsed fregment may rang
from minimal sepration to gross
displacment and displacment with the
epicondyle being pulled into the joint and
trapped between humerus and olecranon

29. treatment
•Minor sepration no reduction but elbow
should be rested incollar and cuff for 3
weeks
•Gross displacement or epicondyle trapped
in joint reduction by manipulation is
sometimes successful but if fails open
reduction and internel fixation is indicated

30. epicondyle Avulsion of lateral
•LESS COMMON
-14year 11
duto traction of extensor muscle from varus
strain of the joint may avulse latral
epicondyl
Since the latral epicondyler epiphysis is not
constant and even appear separately it
exists only for 1-2 year

31. Fracture of proximal end of
radius
•Commn yonge adult and children
mechanism fall on outstretched hand
with elbow extended and forarm pornated
of head aginst cpitulum coused impact
•Fracture of head of radius common in
adult
•Fracture of neck of radius common in
children

32. •Articular cartlage of captulium may
affected
•Spcial features
•Following fall on outstretched arm the
patint complain of pain and local
tenderness posterolatraly over proximal
end of radius and marked pain in
supination and pronation

34. Fractured neck of radius
Mechanism of injury
A full on the outstretched
hand forces The elbow
into valgus and pushed
the radial head against the capitulum
Clinical feature
#Pain in the elbow
#Localized tenderness over radial head
#Pain on rotating the forearm

35. X-ray
d The fracture line is transverse

36. Treatment
Up to 30 degree of radial head tilt and up to
3mm of transverse displacement are
acceptable. The arm is rested in a collar
and cuff and exercise after week
Displacement of more than 30 degree
should corrected pt elbow extended
traction and varus force are applied the
surgeon then push displaced radial
fregment by thumb

37. •If this fails open reduction performed no
need internal fixation following opration
elbow splinted 90 flexion for1-2weeks
Fracture that seen one week or longer after
injury should be un treated except light
splitage

38. Fracture of head of radius . this this could
A-vertical spilt undisplaced, this can be
treated rest on coller and cuff for 2-3 weeks
then active exercise . B-single fragment
displaced of the lateral portion of the head
broken off and usually displaced distally . This
is treated open reduction and fixation by
pinning back the fragment with a kirschner
wire or small screw . C- comminuted fracture –
this is best treated by early excision of the
head, this usually gives an simple excision on
radial head is

39. •The wrist also shold be very carfuly
examined to exclude concomitant injury of
distal radioulner joint called essex lopresti
lesion

40. complications
•Joint staffness may involve both elbow
and radioulner joint
•Recurrent instablity can occure if medial
collatral ligement was injered and radial
head excised
•Osteoarthritis of radiocapitellar joint is late
complication it may call for excion head

42. Fracture proximal ulna
Fructure cronoid proces
bony insirtion of
brachalis muscle so fracture usually avoltion

43. Treatment
•By rest in sling is method of choice except
•When large fregment result in elbow
instablity then open reduction and internal
fixation is indicated

44. Fracture of the olecranion
.the olecranon is subject to both direct and indirect
trauma because of its superficial position .the most
frequent in adult and the elderly patient
diagnosis . Pain graze or bruise over the elbow sugest
commented ,in displaced transvers fracture the
olecranion may be felt in the lower arm and agape
may be palpable the patient unable to extent the
elbow.
Tow types. 1-commented fracture duto dirct truma
•2-clean transvers fracture duto traction when the pt fall
•onto hand while triceps m contracted

45. •X-ray latral veiw show details of fructure
•Treatment1-undisplaced transvers fracture
•Immbolization elbow weth castabout
60degree flexiton for 1 week then exercise
2-displaced transversmay do splintage in
stright position but staffness occure so
opretive treatment is prefer we have three
methods

46. •1-fixation with long cancellous screws
inserted on tipe
•2-tention band wiring
•3-contoured plate and screws
•Complication
•Staffness and malunion
•Osteoarthritis in articuler surface of
trochlea treated by cortisone and
modification activity

47. Bruise in olecranon fracture
Complication of
olecranon fracture
/stiffness ,non union ,
ulnar nerve injury
osteoarthritis is a late
complication.

48. Fracture of capitulum
Mechanism of injuries-fall on the hand with the
elbow straight
Clinical features -fullness in front of the elbow
the lateral side of elbow is tender and flexion is
grossly restritced
Xray -lateral view capitulum or part of it seen in
front of lower humerus and radial head away
from it
treatment.1-undisplaced fracture/treated by
simple splintage or sling for 4-5 days
2--displaced/oprtive reduced and internal fixation

50. Dislocation of the elbow
Seprted 2 articuler surface ulna and radies seprated as
one unite
Displacement postirory -antirorly-medialy or latraly
40asscited with fracture of close structure as avulsion
of medial epicondyle in child and olecranon –
captulium –head of radius – cronoid process fracture
See in any age presented as
1-shorted forarm
2-promenant olecranon p
3-disterbance in triangel

51. Diagnosis
clincly
•x-ray
•Nurovasculer exam

53. Posterior dislocation Lateral dislocation

55. Treatment
Anatomical reduction is essential should be soon as
possible . the majority of cases are treated
conservatively . surgical intervention may be indicated
fore the associated fractures . a-reduction by traction
on the forearm in the position in which it lies ,in order
to over com biceps and triceps shorting , at the same
time the olecranon is pushed forward by thump whilst
the elbow is slowly flexed . the stability is then
checked by gently moving the elbow through its
normal range .b-immobilization . this can be achieved
by collar and cuff with or without a posterior slab for 3
week with elbow at 90 flexed .c-rehabilitation
Shoulder and finger exercise should command at
once .while genteel active . elbow exercise should
common after on week.

57. 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.

58. Pulled elbow- subluxation
of head of radius this conation
occur in infancy and early childhood.
Mechanism of injury is a traction force
applied to the elbow in pronatione leading
to subluxation of the head which becomes
impacted in the orbicular ligament.
this condition responds dramatically to
quick movement of the forearm in to full
supination.

59. Mechanism of pulled elbow
not the radial dislocation

60. Full supination for
mangmente of pulled elbow