Adult elbow injuries

Supracondylar fractures

Mechanism

• Extension type              Hyperextension of arm on outstretched hand/ direct blow

• Flexion type                  Direct force to tip of elbow

Clinical exam, for neurovascular deficit

Management

• Undisplaced - Above elbow backslab for 2 weeks, then active mobilisation

• Displaced - Open reduction and internal fixation with double plating

Intercondylar T or Y #s

Classification -  Riseborough and Radin

 Treatment

1.Open reduction and Internal fixation

•  Method of choice in fit patients

• Surgical exposures

  1. Chevron olecranon osteotomy

  2. Bryan-Morrey triceps sparing approach

  3. Triceps splitting

  4. Triceps tongue flap

• Always identify and protect ulnar nerve

• Fixation

  • Fix articular surface first with wires then screws

  • 1/3 tubular plate to medial side

  • +/- bone graft

  • Reconstruction plate posterolateral side at 90 degrees to the medial plate

  • +/- bone graft

 2.Bag of bones technique

• For elderly osteoporotic patient

• Placing arm in a collar and cuff in flexion, with elbow hanging free.

• Hand and finger movement immediately

• Pendulum shoulder movement from 7-10 days

• Active extension of elbow gradually

• Brown and Morgan reported an average of 70 degrees of motion

 Consider total elbow replacement in elderly patients