As the ELBOW Bends MI Zucker, MD. A dr Z lecture.

As the ELBOW Bends

MI Zucker, MD

A dr Z lecture

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

Normal Fat Pad

The Posterior FAT Pad

• It is ALWAYS abnormal!

Abnormal FAT Pads

• Anterior Fat Pad

• Posterior Fat Pad

The Injuries

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