Elbow Injuries
Supracondylar fracture of humerus
- Innall 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 depending on comfort
- Please discuss each case with your ED duty doctor.
- If necessary refer to on-call Orthopaedic Team.
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.
Elbow x-rays
When reviewing elbow x-ray please check
- Fat Pads (see white arrows in left image)
- Anterior humeral line (throu' ant / mid 1/3 capitellum)
- Radiocapitellar line (Radial shaft alignment with capitellum in ALL views)
- C R I T O L capitellum, radial head, internal epicondyle, trochlea, olecranon, lateral epicondyle
Please see upper limb x-rays for more
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
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]
"Pulled Elbow"
- Child (1 to 6 years). History of traction injury, not using arm (often kept "limp" in extension).
- 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
Fractures of the capitellum or epicondyles of the humerus
- Always check C R I T O L
- Refer to on-call Orthopaedic Team (Referral form)
- Consider X-ray of opposite elbow for comparison in children.
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.
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
