Elbow Fractures Part III
Radial Head Fracture
Radial had fractures are a common fracture in adults when the individual falls with there are outstretched and forearm in pronation or supination. Radial head fractures may occur alone or they may occur with dislocation and or a coronoid fracture. If all three are present then it is considered a “terrible Tiriad”.
Radial Head fractures can be confirmed through X-rays. Patients will presents with swelling at the joint, point tenderness at the radial head, decrease Ability to actively and passively flex/extend/supinate/pronate elbow.
Radial head fractured can are placed into 4 separate categories:
Type I- Fracture without displacement
Type II- Fracture with displacement
Type III- Comminuted fracture with displacement
Type IV- Comminuted fracture with dislocation
Type I and II may be treated with non-operative treatment if nondisplaced or minimally displaced. Early passive mobilization is to be established. At 3 weeks may progress towards strengthening isometric (3 weeks) to isotonic (8weeks). Active assisted ROM may be initiated. At 6-8 weeks active ROM may begin.
Type II, III, and IV fractures may be treated with fixation. Rehab is similar with minimum protective phase (return to normal activity) at 12 weeks versus 8 for non-operative fractures.
Supracondyle Fracture (upper extremity Injuries in pediatric athlete)–>all ped fractures
Supracondyle fractures account for 75% of all pediatric elbow fractures and occurs in children ages 5-10 years old. 95% of factures result in displacement of the distal fracture. They are placed into 3 categories:
Type I- Minimally displaced–> treat with long arm cast at 90-100 degrees
Type II- Posterior hinged displacement–>Closed reduction and casting
Type III- Complete displacement–>Closed reduction and percutaneous pinning, motion beings after pins are removed at 4 weeks
Coronoid fractures coincide with elbow dislocations and possible radial head fractures. The fractures may occur during the dislocation but often present with an unstable elbow joint following a dislocation. The fractures may be secondary to a shear force during the dislocation or an avulsion fracture may occur at the insertion side of the brachialis. An avulsion fracture may case an unstable reduction or may cause the dislocation to be irreducible
If the fracture restricts elbow motion, then it is an indication for surgical intervention. It may be fixed using an internal fixation or if more sever and external fixation. Type 1 and 2 fractures are managed non-operatively.
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