Fractures of the Elbow

Fractures of the Elbow

Skeletal fractures of the elbow characteristically result from blunt trauma or falling on an outstretched arm. Although occult fractures of the elbow are uncommon, neurovascular pathology is of great concern when managing these injuries. Close attention should be paid to sensorimotor distribution of the median nerve because it is commonly injured with fractures to the distal humerus, regardless of displacement. Monitoring the brachial artery is also imperative because it is additionally vulnerable to injury. If the brachial artery sustains an injury that is not appropriately managed, Volkman’s ischemic contracture may result. Treatment for distal humeral fractures should include application of a comfortable compressive dressing and immobilization of the elbow with a rigid long-arm splint in the position of

presentation. If involvement of the humeral condyles is suspected, splinting should be more specific. If the lateral condyle is affected, splint the forearm in supination with the wrist in extension so as to alleviate tension on the wrist extensor musculature. If the medial condyle is fractured, the wrist should be splinted in pronation and flexion so as to ease tension on the wrist common flexor tendon. Properly controlling effusion and edema of the elbow complex is advantageous because a delayed onset of swelling can periodically result in neurovascular compromise. Urgent referral to an orthopedic specialist for advanced care is highly recommended. Significant complications such as misalignment and decreased elbow joint range of motion are often probable if these fractures are not realigned correctly.

Special consideration should be given to the olecranon if suspected of fracture because adverse morbidity often ensues if managed poorly. Fracture of the olecranon is recognized as an intraarticular lesion and calls for intricate realignment to ensure favorable outcomes. Displaced olecranon fractures routinely rupture the triceps aponeurosis and subject the ulnar nerve to compromise. As such, displaced fractures of the olecranon should be immobilized in the position of presentation with a rigid splint and warrant

immediate activation of EMS for comprehensive care. If these particular fractures prove to be nondisplaced, the affected forearm may be immobilized in a long-arm splint with the elbow joint flexed to 70 degrees and the wrist joint in neutral. Complications that may arise from improper care include cubitus valgus or varus deformity, malunion, arthritis, and ulnar nerve palsy.

Fractures of the radial head and neck are commonly related to avulsion of the humeral lateral epicondyle or capitellar injury. It is important that these fractures be immobilized in a rigid long-arm splint and that the athlete immediately be transported to the nearest emergency medical facility for proper follow-up care. Advanced diagnostics are usually required to assess potential displacement and degree of angulation prior to attempting realignment of the fracture. It is vital that athletic trainers assess integrity of the distal radioulnar joint subsequent to radial head and neck fractures.

Violent mechanisms of injury to the radial head and neck may occasionally result in an Essex-Lopresti fracture.

This pathology manifests as rupture of the interosseous membrane and warrants immediate activation of EMS for comprehensive care. Substantial morbidity may result from negligible treatment of an Essex-Lopresti fracture. In managing elbow skeletal fractures, it is of utmost importance that

neurovascular processes be monitored intermittently with deficiencies or alterations accounted for. Moreover, athletic trainers must be alert for the potential onset of acute compartment  syndrome secondary to skeletal fracture.

Fractures of the Humerus

and Shoulder

Proximal humeral fractures typically occur in the athletic population as the result of trauma, most likely secondary to falling on an outstretched arm. These fractures may also occur from a direct blow to the lateral aspect of the bone, although this is rare. On examining this specific pathology, athletic trainers may advise the injured athlete to hold the involved arm in an adducted position. Symptoms usually include considerable pain, edema, and focal tenderness over the proximal humerus. The athletic trainer must thoroughly inspect the injured anatomy for any gross deformity that could place the brachial plexus, axillary nerve, and vascular structures in danger of

compromise. Occasionally, a proximal humeral fracture can accompany a glenohumeral joint (GHJ) dislocation and most often occur from extreme forces imparted on the shoulder complex. Typically GHJ fracture-dislocations cause the anatomical area to be more susceptible to related rotator cuff lesions and brachial plexus and axillary neurovascular pathology.

Basic emergency medical care typically includes seating the athlete upright for elevation and placing the injured extremity in an appropriate arm sling and swathe. The careful application of ice for pain and spasm control may be incorporated. In addition, prompt transport of the injured athlete to the nearest emergency medical facility is necessary for proper follow-up care. Potential complications resulting from inappropriate treatment include malunion healing,myositis ossificans, secondary GHJ stiffness, and arthritis. Adjunct complications for failure to recognize associated pathology to the greater and lesser tuberosities include nonunion healing of the respective osseous structures and tenosynovitis of rotator cuff musculotendinous tissues. Special attention must be considered when caring for the skeletally immature athlete because avascular necrosis (AVN) may also result from inadequate management of these conditions. Fractures to the humeral shaft are most often a consequence of either direct or indirect forces. A direct force to the humerus, such as a violent blow, frequently results in a transverse fracture of the bone. An indirect force, however, such as landing on an outstretched arm or the elbow, will likely result in a spiral fracture. As a result of the large cross-sectional area of musculature spanning the humerus, realignment tends to be difficult.Assessment of neurovascular tissues subsequent to humeral shaft fractures, especially the radial nerve, is essential. Fractures to the middle and distal third of the

humerus carry the potential for radial palsy, which is exemplified by wrist-drop or an inability to actively extend the wrist of the injured arm.5 Hence, it cannot be overstressed that athletic trainers perform a complete examination of the shoulder and elbow joints to rule out occult injuries. The onset of neurovascular compromise necessitates immediate activation of EMS. Appropriate interventions for successfully managing humeral shaft fractures depends on the presence of displacement and the degree of angulation or accompanying neurovascular pathology. If displacement is not evident, the fracture may be immobilized with a rigid long-arm splint

and the athlete must be transported to the nearest emergency medical facility for proper follow-up care. However, if displacement is noted, the affected extremity should be immobilized with a rigid long-arm splint in the position of presentation and immediate activation of EMS for comprehensive

care is warranted. Failure to appropriately manage humeral shaft can accompany a glenohumeral joint (GHJ) dislocation and most often occur from extreme forces imparted on the shoulder complex. Typically GHJ fracture-dislocations cause the anatomical area to be more susceptible to related rotator cuff lesions and brachial plexus and axillary neurovascular pathology. Basic emergency medical care typically includes seating

the athlete upright for elevation and placing the injured extremity in an appropriate arm sling and swathe. The careful application of ice for pain and spasm control may be incorporated. In addition, prompt transport of the injured athlete to the nearest emergency medical facility is necessary for proper follow-up care. Potential complications resulting from inappropriate

treatment include malunion healing,myositis ossificans, secondary GHJ stiffness, and arthritis. Adjunct complications for failure to recognize associated pathology to the greater and lesser tuberosities include nonunion healing of the respective osseous structures and tenosynovitis of rotator cuff

musculotendinous tissues. Special attention must be considered when caring for the skeletally immature athlete because avascular necrosis (AVN) may also result from inadequate management of these conditions.

Post a Comment

0 Comments