elbow trauma

©Ken L Schreibman, PhD/MD 2010 schreibman.info

Elbow Trauma Anatomy

3D Dislocations

Radial Head Fractures

Radial HeadForearm

PatternsChildren

Examining Elbow Radiographsschreibman.info

Elbow Anatomy

Elbow AnatomyCapitellum[L. small head] ball-shaped

Trochlea[Gr. pulley] spool-shaped

Radial Head disc-shaped

Olecranon[Gr. elbow]

RADIUS

TROC CAP

HUMERUS

HEADOLEC

Elbow Anatomy

Elbow Anatomy HUMERUS

RADIUS

OLECRANON

CORONOIDON

CORACOID

RADIUS

OLECRANON

CORONOIDON

CORONOID

Elbow Dislocations

LateralView

Olecranon & Radial HeadEasy!

APView

Relocated

Elbow Dislocations: Parallelism

APView

Relocated

APView

Dislocated

ParallelArticularSurfaces

Lack ofParallelism

LateralView

Relocated ParallelArticularSurfaces

ParallelArticularSurfaces

Elbow DislocationsOlecranon & Radial HeadEasy!

Radial Head OnlyCan be very subtle

Keys to Examining ElbowsRadial Head points to Capitellumon all views

RADIUS

CAPTROCRadial Headpoints to

Capitellum

Radial Headpoints to

Capitellum

Elbow Anatomy

Capitellum

Elbow Anatomy

Capitellum

Elbow Anatomy

Capitellum

Elbow Anatomy

Capitellum

Elbow Anatomy

Capitellum

Elbow Anatomy

Capitellum

Elbow Anatomy

Capitellum

Elbow Anatomy

Capitellum

Elbow Anatomy

Capitellum

Elbow Anatomy

Capitellum

Elbow Anatomy

Capitellum

Elbow Anatomy

Capitellum

Elbow Anatomy

Capitellum

Elbow Anatomy

Capitellum

Elbow Anatomy

Capitellum

Elbow Anatomy

Capitellum

Elbow Anatomy

Capitellum

Elbow Anatomy

Capitellum

AP LateralCongenital Radial Head Dislocation4 year-old maleNo traumaCould not

supinate arm

Lateral

RightLeft

Elbow DislocationsOlecranon & Radial HeadEasy!

Radial Head OnlyCan be very subtle

10 year-old femaleAP Lateral--------- Not a True Lateral

True Lateral

Monteggia Fracture

HUMERUSCAP

CARPUS

RADIUS

Monteggia Fracture

HUMERUS

CARPUS

RADIUS

Monteggia FracturePost Reduction

Monteggia FractureGiovanni Battista Monteggia (1762-1815)Greatest Italian Surgeon

beginning 19th century

Hunter, Peltier, LundRadioGraphics2000:20;819-836

Fx Prox 1/3 UlnaAnt Disloc Rad Head

Monteggia Fracture

Bado’s classification of Monteggia fractures

Monteggia Fracture

Forearm Fractures

HUMERUSCAP

CARPUS

RADIUS

Forearm Fractures

HUMERUSCAP

CARPUS

RADIUS

: Galeazzi: Galeazzi

Riccardo Galeazzi (1866-1952) Developed Orthopedic Rehab in ItalyCrippled soldiers/children wounded WWI

Galeazzi Fracture

Fracture Middle-Distal ⅓ RadiusDislocation of the Distal Radio-Ulnar Joint (DRUJ)

Galeazzi Fracture << Monteggia

Fracture Middle-Distal ⅓ RadiusDislocation of the Distal Radio-Ulnar Joint (DRUJ)

Monteggia vs Galeazzi: mnemonic

HUMERUS

CARPUS

RADIUS

HUMERUSCAP

CARPUS

RADIUS

MU/GRM GU R

Forearm Fractures

HUMERUSCAP

CARPUS

RADIUS

: Nightstick Fx: Nightstick Fx

Forearm Fractures: Nightstick Fx: Nightstick FxChicago, 1968

Forearm Fractures

2 months later

: Nightstick Fx: Nightstick Fx

Both Bone Forearm Fracture

HUMERUSCAP

CARPUS

RADIUS

Common in childrenCan look scary…

…but should heal well “if both ends of the bone are in the same room”

Both Bone Forearm FractureAP View7 Months Later

Lateral View

12 year-old Male

Essex-Lopresti Fracture

IOMULNA

HUMERUSCAP

CARPUS

RADIUS

Essex-Lopresti FracturePeter Gordon Essex-Lopresti (1918-1951)British Surgeon, Air Borne Div, WWIIExpert on Parachuting InjuriesClassification scheme for Calcaneal Fxs

Radial Head Fx w/ Disruption DRUJ Displaced Rad Head Fx Examine Wrist Closely

Impacted, ComminutedRadial Head Fracture

Lack ofParallelism

Impacted, ComminutedRadial Head Fracture

Radial HeadProsthesis

Lack ofParallelism

Parallel articular surfaces

PostRadial HeadProsthesis

Keys to Examining ElbowsRadial Head points to Capitellumon all viewsFat Pads are your Friend

Elbow Fat PadsHUMERUS

RADIUS

Elbow Fat Pads

U L N AR A D I U S

HUMERUS

Anterior Fad Pad(Coronoid Fossa)Posterior Fad Pad

(Olecranon Fossa)

Resnickfig22-15

With a radial head fracture:Bleeding into joint

(hemarthrosis)Elevates the Fat Pads

Resnick fig22-16

Elbow Fat Pads

U L N AR A D I U S

HUMERUS

Normally, can’t see Posterior Fat Pad(tucked in olecranon fossa)

Anytime youcan see it,indicates it is displaced…probably by hemarthrosis

Keys to Examining ElbowsRadial Head points to Capitellumon all viewsFat Pads are your FriendMost Radial Head Fractures are non-displaced and hard to seeAdults = Radial Head Fracture

Elevated Fat Pad = Radial Head Fx

U L N AR A D I U S

HUMERUS

Lateral

APOblique

Elevated Fat Pad = Radial Head Fx

EXTROT

Radial Neck is Outside Joint Capsule

Resnickfig22-15

Radial Neck fracturedoes not cause a hemarthrosis, anddoes not elevate the fat pads.

Radial Neck is Outside Joint Capsule

Resnickfig22-15

No Fat PadElevation

Keys to Examining ElbowsRadial Head points to Capitellumon all viewsFat Pads are your FriendAdults = Radial Head FractureChildren = Supracondylar Fx

Anatomy

RADIUS

HUMERUS

TROC CAP

Anatomy

RADIUS

HUMERUS

Articular surfaces unossified at birthOssify in orderC R I T O ECapitellumRad HeadInt (med) EpiTrochleaOlecranonExt (lat) Epi

: Ossification Centers: Ossification Centers

2 year-old female

…..2

…..4..6

…….8…

Elbow Fractures: Children

RADIUS

HUMERUS

Supracondylar Fracture 60% Elbow Fxs in

Children SubtleGrossly

Displaced

RADIUS

HUMERUS

2 year-old female

Displaced

Right (painful side) Left (normal side)

Elbow Fractures: ChildrenSupracondylar Fracture 60% Elbow Fxs in

Displaced

Supracondylar Fracture

AnteriorHumeral

LineShould passthru middleCapitellum

Anterior Humeral LineShould pass thru middle ⅓

Capitellum

Supracondylar Fracture

5 year-old female

Day of injury After 2 weeks After 5 weeks

(Lateral Condyle Fx)Anterior Humeral LineShould pass thru middle ⅓

Capitellum

Elbow Fractures: ChildrenLateral Condyle Fracture2nd most common pediatric elbow Fx20% of elbow injuries in children

6 year-old female

Elbow Fractures: ChildrenLateral Condyle Fracture2nd most common pediatric elbow Fx20% of elbow injuries in children

Left (painful side)Right (normal side)

CapitellumWhen in doubt, get the other side

C R I T O ECapitellumRad HeadInt (med) EpiTrochleaOlecranonExt (lat) Epi

…..2

…..4..6

…….8…

14 year-old male

Left (painful side)Right (normal side)

Width of normalgrowth plate

Abnormallywidenedgrowthplate

Avulsion Medial Epicondyle“Little Leaguer’s Elbow”Traction common

tendon flexor-pronator group

Traction UCLResult of

valgus stressFall on out-

stretched handViolent

throwingcontractions

CapitellumWhen in doubt, get the other side

elbow trauma

elbow anatomy ken

elbow anatomycapitelluml

Documents

elbow pain - acecicelbow pain can result directly from an...

novel insights in elbow trauma - uva · novel insights in...

elbow and forearm conditions disability benefits …...jun...

cdn.ymaws.com · the shoulder, upper extremity trauma,...

chapter 23: the elbow. anatomy of the elbow

anatomy of the elbow tennis elbow golf elbow de quervain's...

elbow support elbow

musculoskeletal disorders and prevention · golfer’s...

failure to follow instructions may lead to patient...

novel insights in elbow trauma - uva · 212 novel insights...

repetitive trauma disorders of the elbow, wrist, & hand...

elbow trauma. 6% of all fractures and dislocations involve...

elbow injuries. anatomy elbow dislocation elbow bursitis

elbow fractures orif vs arthroplasty · 1/4/2017 · total...

the complete guide to tennis elbow · 2019-11-11 · tennis...

elbow pain - acecic.co.uk · pain can occasionally radiate...

objectives of this discussion - cloudcme · • “tennis...

a rare cause of elbow pain: hegemann’s disease · were...

uva-dare (digital academic repository) posttraumatic elbow...

orthopaedic and trauma course for emergency medicine ·...