As the ELBOW Bends
MI Zucker, MD
On Common Injuries of the Elbow and Forearm
of ADULTS and KIDS
ANATOMY: Adult
• AP View
ANATOMY: Adult
• Lateral View
ANATOMY: Kid
• AP View
ANATOMY: Kid
• Lateral View
ANATOMY: KidSpecial Lines
• Anterior Humerus Line
• Radius-capitellum Line
The Famous FAT PADS
• Anterior and Posterior
• Intracapsular and extrasynovial
Anterior FAT Pad
• It is normal, but only when it’s normal!
• Sharp, small, hugs bone
The Posterior FAT Pad
• It is ALWAYS abnormal!
Abnormal FAT Pads
• Anterior Fat Pad
• Posterior Fat Pad
RADIUS HEAD Fractures
• Very common• Can be obvious, but
often very subtle or occult
• Almost always have abnormal fat pads
Radius Head Fractures
• Most treated very conservatively: 3 weeks in a sling, physical therapy.
Radius Head Fractures
• A few need surgery• The Rule of 3’s
If more than:
– 1/3 of articular surface involved
– More than 30 degrees angulation
– More than 3mm depression
Olecrannon Process Fractures
• Unstable due to triceps muscle traction
• ORIF
Coronoid Process Ulna Fractures
• May be isolated
-but-
Dislocation
• May be a subtle clue to a spontaneously or patient-reduced dislocation, with severe ligament instability
Adult Supracondylar Fractures
• Not subtle, high energy, very unstable
• ORIF
The KID Elbow
• CRITOE• The appearance of the
growth centers
The Big 3 of the KID Elbow
• Supracondylar fracture• Lateral Condyle
fracture• Medial Epicondyle
avulsion
(In order of prevalence)
Supracondylar Fractures
• Fraught with complications:
Vascular
Nerve
Osseous
Lateral Condyle Fractures
AP
Medial Epicondyle Avulsion Fractures
• Little Leaguer’s or Pitcher’s Elbow
Acute
-or-
Subacute (stress)
Medial EPICONDYLE Avulsion Fracture
• Remember: CRITOE
• Internal (medial) epicondyle
-appears BEFORE-• Trochlea
Fractures of the RADIUS and ULNA Shafts
• Adults and older children:
• Unstable. ORIF
• In kids, frequently closed reduction and cast is OK
MONTEGGIA Fracture
Proximal ULNAR Shaft Fracture
-and-
RADIAL Head Dislocation
ORIF
GALEAZZI Fracture
Distal RADIAL Shaft Fracture
-and-
Distal ULNAR Dislocation
ORIF
Parry Fracture
• AKA “Nightstick Fracture”
• Isolated usually nondisplaced ULNA shaft fracture
KID Forearm Fractures
• Elastic bowing• Plastic bowing• Greenstick• Torus or buckle
Elastic and Plastic Bowing
• Microfractures
Incomplete or Greenstick Fractures
One margin of cortex remains partially intact
Combined
• Plastic bowing deformity of one bone
• Greenstick or complete fracture of the other bone
Torus or Buckle Fracture
• Obvious
• Subtle
Torus or Buckle Fracture
• The LATERAL view is very helpful in subtle cases
• Look for the BUMP
INTENTIONAL INJURY
• CHILD ABUSE
An acute and subacute fracture of the ulna and a dislocation of the radius head
INTENTIONAL INJURY
• “SELFOGENIC”
Paper clips
GOODBYE
• Copyright 2004
MI Zucker, MD