ELBOW FRACTURES

Distal humerus1. supracondylar fractures, 2. transcondylar fractures, 3. intercondylar fractures, 4. fractures of the condyles 5. fractures of the articular surfaces (capitellum

and trochlea)6. fractures of the epicondyles.• Intra articular fractures• Muscle forces

EXTRA - ARTICULAR

PARTIAL - ARTICULAR

COMPLETE - ARTICULAR

JUPITER AND MEHNE

NON SURGICAL MANAGEMENT

• Medically unfit

• Paralytic arm

• undisplaced

SURGICAL MANAGEMENT

• PRINCIPLES-1.Open reduction – reconstruct the articular

surface

2.Rigid fixation

3.Early mobilization

Reconstruction of articular surface

Rigid fixation

1. AO 90*-90* configuration

2. Parallel plate configuration

Total elbow arthroplasty

• Indications-1.Grossly communited # in a osteoporotic pt

2.Pre existing rheumatoid arthritis.

3.If reconstruction impossible.

early rehab

• Splint 30-40 * of flexion and neutral location• Allow healing of skin sutures• Active assisted exercises• Immobilize max 2-3 weeks• Resistance exercises at radiographic union or

8-12 weeks• After total elbow- do not pick up wt > 5

pounds

Elbow arthrodesis

• severe bone or soft tissue loss.• chronic persistent infection,• concominant neurologic injury,• failed TEA• Unstable elbow

Capitellar fractures

• Intra articular #

• Coronal plane

• No muscle attachment

• Can become a mechanical block if displaces ant.

CORONOID FRACTURES

Radial head fractures

• Isolated or as a complex injury• Now we know that radial head is not

expendable• Cx of excision-1.pain, joint instability, cubitus valgus

2.proximal radial translation,

3.Dec strength, osteoarthrosis

TYPE 1

• Undisplaced fractures

• < 2mm displacement

• No mechanical blockRx- 1.sling till pain relief2.24-48 hrs later start active ROM exercises

TYPE 2

• Less than 3 fragements• 1/3rd of the radial head • Rx-• ORIF –1.Mini condylar plate 2.Mini fragment screw3.Herbert, accutrak4.Mayo radial head plate

REDIAL HEAD EXCISION

• TYPE 3- which are not amenable to ORIF

will need excision

• Provided there are isolated

• Early excision versus delayed excision

arthroplasty

• Type 3 or 4 with-1.ligament injury 2.distal radioulnar joint injury3.coronoid fracture4.olecranon fracture that is displaced or

comminuted and unstable