injuries around elbow joint orthopaedics ppt

injuries around elbow joint orthopaedics ppt

1. Injuries Around the Elbow

2. FRACTURE OF THE OLECRANON This is usually seen in adults. It results from a direct injury as in a fall onto the point of the elbow.

3. PATHOANATOMY The proximal fragment may be pulled proximally by the attached triceps muscle, thus creating a gap at the fracture site. The fracture may be one of the three types (Fig-14.20).

4. DIAGNOSIS Pain, swelling and tenderness are present at the point of the elbow. A crepitus or a gap between the fragments may be present. Active extension of the elbow is not possible in fractures with a gap The diagnosis is confirmed on an X-ray

5. TREATMENT Type I: A crack without displacement is treated by immobilizing the elbow in an above-elbow plaster slab in 30 degree* of flexion. After 3 weeks the plaster is removed and elbow exercises begun. Type II: A clean break with separation of the fragments is treated by open reduction and internal fixation using the technique of tension-band wiring . It is not possible to keep the fragments together in the plaster alone because of the constant pull exerted by the triceps.

6. Type III: A comminuted fracture, if not separated, is treated in a plaster slab as in type-I, but if the fragments are separated, tension-band wiring or excision of the fragments may be required. With improvement in methods of internal fixation, fracture of the olecranon, being an intraarticular fracture is treated by internal fixation wherever possible. This helps in early mobilisation of elbow,

7. COMPLICATIONS Non-union is a common complication in cases with a gap at the fracture site which prevents the fracture from uniting. Treatment is by open reduction, internal fixation and bone grafting Elbow stiffness occurs in some cases. Treatment is physiotherapy Osteoarthritis occurs late, often after many years

8. PULLED ELBOW This condition occurs in children between 2-5 years of age. The head of the radius is pulled partly out of the annular ligament when a child is lifted by the wrist. The child starts crying and is unable to move the affected limb. The forearm lies in an attitude of pronation. There may be mild swelling at the elbow

9. It is not possible to see the subluxated head on an X-ray because it is still cartilaginous; X-rays are taken only to rule out any other bony injury. Treatment: The head is reduced by fully supinating the forearm and applying direct pressure over the head of the radius. A sudden click is heard or felt as the head goes back to its place. The child becomes comfortable and starts moving his elbow almost immediately.

10. DISLOCATION OF THE ELBOW JOINT Posterior dislocation is the commonest type of elbow dislocation. Other dislocations are postero-medial, postero-lateral, and divergent . It may be associated with fracture of the medial epicondyle, fracture of the head of the radius, or fracture of the coronoid process of the ulna.

11. The three bony points relationship is reversed. There is often an associated median nerve palsy. Clinically, there is severe pain at the elbow. The triceps tendon stands prominent (bowstringing of triceps). Diagnosis is easily confirmed on X-rays

12. Treatment It is by reduction under anesthesia followed by immobilisation in an above-elbow plaster slab for 3 weeks Elbow stiffness and myositis are common complications