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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

Type 1   

 Non displaced # between capitellum and trochlear

Type 11   

  Separation of capitellum and trochlear without rotation of fragments in frontal plane

Type 111   

   Separation of fragments with rotation

Type 1V   

  Severe comminution with wide separation of condyles

 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



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