Trauma - Elbow Injuries

Elbow Injuries



Elbow x-rays

When reviewing elbow x-ray please check:

  1. Fat Pads (see white arrows in left image)
  2. Anterior humeral line (throu' ant / mid 1/3 capitellum)
  3. Radiocapitellar line (Radial shaft alignment with capitellum in ALL views)
  4. C R I T O L capitellum, radial head, internal epicondyle, trochlea, olecranon, lateral epicondyle

Please see upper limb x-rays for more

Dislocation of the elbow

  • Needs urgent reduction. 
  • Call senior ED staff or refer to the on-call Orthopaedic Team
  • Check neurovascular status.

Fractured olecranon

  • Refer to the on-call Orthopaedic Team for ORIF with wires.

"Pulled Elbow"

  • Child (1 to 6 years). History of traction injury, not using arm (often kept "limp" in extension and pronated - almost "waiters tip").
  • No signs clavicle, shoulder or wrist injury.
  • Poorly localised elbow tenderness. Pain on elbow movements especially rotation.
  • Pronation with or without elbow flexion is the first line method of reduction for pulled elbows [BestBets]
  • Listen or feel for click. Leave child for a few minutes and then observe function.
  • If no recovery consider X-ray and if normal X-ray, review (ED Clinic) after one day if not using arm normally.

Supracondylar fracture of humerus#

  • In all children check (1) Fat pads (2) Ant humeral line (3) Radiocaptetellar line (4) CRITOL (please see x-rays section)
  • Check and record neurovascular status.
  • Simple undisplaced fractures may be placed in a sling or full length POP (90°) depending on comfort.
  • Please discuss each case with your ED duty doctor.
  • If necessary refer to on-call Orthopaedic Team.
Supracondylar fracture Supracondylar fracture
Supracondylar #

Fractured neck/head of radius

  • Check radial pulse
  • Assume an intra-articular (or supracondylar) if mal-alignment or effusion seen
  • Treat fractured head of radius with analgesia and a broad arm sling.
  • If gross displacement / comminution refer to on-call Orthopaedic Team.
  • Therapeutic aspiration is not our routine practice [BestBets]
  • Otherwise refer to the next Fracture Clinic. Referral form)
  • Repeat radiography is not needed for traumatic elbow effusions with no fracture on initial x-ray [BestBets]

Radial Head / Neck # Mason Johnston Classification

I - Nondisplaced

II - Minimally displaced with depression, angulation and impaction

III - Comminuted and displaced

IV - Radial head # with dislocation of the elbow


Lateral epicondyle

  • Usually FOOSH.
  • Record neurovascular examination findings.
  • Always check C R I T O L, Ant Humeral line, Radiocapitellar line and fat pads.
  • Typically Salter Harris iv.
  • Often subtle x-ray findings, sometimes just positve ant/post fat pads.
  • Consider oblique or X-ray of opposite elbow for comparison in children.
  • Refer to on-call Orthopaedic Team. These fractures have poor prognosis (mal/non union). Undislaced fractures may be treated (after ortho consult) in a above-elbow PoP (90° flex) and fracture clinic. Any rotation or displacement (esp if >2mm) need surgery (ORIF) today.
Lateral Epicondyle Lateral Epicondyle
# lateral epicondyle - beware

Medial epicondyle

  • Usually pull off # with valgus stress on elbow (beware dislocation).
  • Beware intra-articular condylar # (all need ORIF) rather than epicondyle #.
  • Record neurovascular examination findings.
  • Always check C R I T O L, Ant Humeral line, Radiocapitellar line and fat pads.
  • Minimal displaced medial epicondylar # = PoP backslab (90° flexion) and fracture clinic follow up.
  • Displaced #, elbow dislocation or intra-articular condylar # = ortho referral now for ORIF.
Medial Epicondyle Medial Epicondyle
# medial epicondyle

Dislocated head of radius  (abnormal radiocapitellar line)

  • Radiocapitellar line should be good in all (even oblique) x-rays views
  • Often associated with a fracture of the ulnar shaft (Montegia fracture-dislocation).
  • X-rays of the whole forearm are required for diagnosis.
  • Beware neurovascular compromise.
  • Refer to on-call Orthopaedic Team for orif today.
Dislocated radial head Dislocated radial head
Radial head dislocation

Forearm

Fractured shaft of radius and ulna

  • Refer to on-call Orthopaedic Team.

Dislocated head of ulna

  • Usually associated with a fracture of the radial shaft (Galeazzi fracture-dislocation - image right) and X-rays of the whole forearm are required for diagnosis.
  • Refer to on-call Orthopaedic Team
Galeazzi 1

Content by Dr Íomhar O' Sullivan 22/02/2004. Reviewed by Dr ÍOS 17/05/2005, 05/07/2005, 07/05/2007. Last review 12/12/17.