Fracture & dislocation around the elbow Taiz University,faculty of medicine and health sciences By Dr Asma Mahuob

1. Fracture &
dislocation
around the
elbow

2. Anatomy of the Elbow
Bone of elbow
1-humerus
2-radus
3- ulna

3. Bony part
It is synovial hinge joint
between
A- the trochlea and the
capitulum of the
humerous AND
B- the trochlear notch of
the ulna and the upper
surface of the head of
radius

4. Elbow joint (ligament)
1- radial collateral lig.
2- anular lig. Of radius
3- ulnar collateral lig.
4- transverse lig.

5. .1Vbbnjjmjujmm

6. ulnar ligament called also the
medial collateral ligament. It
prevent abduction ‫تباعد‬of elbow
joint. It cosists of 3 bands:
Anterior, posterior, Transverse.
radial ligament called also
The lateral collateral ligament.it
prevent adduction of elbow

7. Muscles

9. Artery&Nerve
Median n
radial n
ulnar n

10. movement in the region of
the elbow
Two sits of movements occur in the region of elbow
A/flexion and extension . at the elbow joint
B/pronation and supination . At Superior radio-ulnar joint
Flexors muscle 1/brachialis 2/biceps 3/brachio-radialis
4/flexore of forearm
Extensors muscle 1/triceps 2/anconeus
Pronator 1/pronator teres 2/pronator quadratus
Supinators
1/biceps 2/supinator.

11. Movement of elbow

12. fracture Hx & Ex

13. Clinical manifistation in Median
nerve injury

14. Wrist drop in case of radial
nerve injury

15. fructures OF THE ELBOW
 fractures of distal end of the humerus
 fracture of proximal end of radius
 fracture of the proximal of the ulna
 Avulsion fracture
◦ Avulsion of the epiphysis of the medial
epicondyle
◦ Avulsion fracture of the epiphysis of the
lateral epicondyle

16. Fractures of distal humerus
 Mechanism of injury: -high energy except in
osteoporotic.
-falling on flexed elbow > 90 degree.
 classification [ A O ] : divided into:
- type A: extraarticular
- typeB: intraarticular unicondylar frct .[one
condyle sheared off and the still in contact with the
shaft.
- typeC: intraarticular bicondylar [no one in
contact with the shaft] . has subgroups:- simpleTorY
- extraarticular
comminution
- intraarticular
comminution

18. Fracture of the distal end of
the humerus
Classification :
1- Supracondylar.
2- Condylar.
3- Intercondylar.

20. 1- Supracondylar fractures
The commonest fracture in
children
boy are injured more than girls and
more of patient are under 10 years

21. Supracondylar fracture
Tow type of supra condylar fracture
according to the direction of distalthe
fragment (direction of displacement)
A/supracodylar fracture with posterior
displacement of distal fragment
*extension type* account 95% of case
cause by fall on the hand with elbow bent

22. Supracondyle fracture with
posterior displacement

23. b/supracondylar fracture with anterior
displacement of distal fragment
flexion type it account 5% of cases it
cause by a fall on hand with elbow
extended

24. Classification according to
severity of degree of wilkint
Type 1- undisplaced fracture
Type 2- Green stick fracture with
angulation
A- less sever and angulated
B- more sever and both angulated and
Malrotated.
Type 3- completely displaced fracture

25. DIAGNOSIS
Following the fall child
complain of pain in
the elbow and
tenderness in the
distal humerus and
swelling and deformity
but the olecranion and
medial , lateral
epicondyles preserve
their normal
equilateral triangular
relationship
X- ray :AP &Lat

26. It is essential to examine
fore neurovascular
damage .the brachial
artery may be affected so
pulse examination is
essential also nerve
injury commonly median
nerve

27. management
1*supracodylar fracture with posterior
displacement –our aim is to secure reduction with no
angulation or rotation . the conservative method is the
method of choice
A*reduction 1/the surgeon exert traction on the injured limb
with elbow slightly flexed then flexed the elbow to 80with
while pushing forward the lower fragment with his thump.*the
radial pulse must be checked if the pulse weak or disappear
the degree of elbow flexion is reduced until the pulse returns .
B*immobilization by simple collar and cuffis applied .
C*rehabilitation immobilization should be continue for 3week
after that the child allowed to take the hand out of the cuff for
activities such as washing ,dressing and writing. Elbow
flexion is encouraged but not extension .operative method
indicated if there is vascular damage , the fracture may
fixed using kireschner wire ..

29.  2*supracondylar fracture with
anterior displacement . this usually
reduced by pulling the arm with the
elbow fully extended . immobilization
is achieved by a plaster slab with the
elbow extended for3weeks following
by active gradually elbow flexion

30. Internal fixation of supracondylar
fracture

31. Complication of supracondylar
fractures
 1 - early complications
 a/vascular injury : which if untreated will
lead to volkmanns ischaemia
 b/nerve injury : the median , ulnar and
radial nerve are some time injured but
usually recover spontaneously .the most
common affected is the median nerve..
 2 - late complications
 a/myositis ossificans . b/stiffness of
joint c/malunion . d/late
ulnar palsy.

37. Dislocation of the elbow
Dislocation of ulnohumeral joint in adult more
than in children , radioulnar complex is
displaced posteriorly or posterolateral often
together with fractures.
Mechanism of injury 1
Posterior dislocation *the common type
1-because fall on the out striated hand with the
elbow extend .2-disruptur of
capsuloligamentous structure alone it also
lead to posteriolateraly
dislocation.*dislocation without recurrent
dislocation . not the combination of fractures.

38. Posterior dislocation Lateral dislocation

39. If there is tissue damage may combined
with surrounding nerve and vesicular
damage
sid-swip injury / in car drivers elbow the
result forward dislocation with fracture
of bone around elbow , soft tissue
damage usually sever
Clinical features slight flex hand ,
swelling , deformity , bony land mark
in abnormal place , pain ,the hand
should be examine for neurovesicular
damage

40. 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.

41. Anterior dislocation

42. 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.

43. 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 .

44. Pulled elbow

45. Mechanism of pulled elbow
not the radial dislocation

46. Full supination for
mangmente of pulled elbow