Elbow Dislocation Management Quiz

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the recommended initial approach to manage a complex or unstable elbow dislocation?

Immediate passive range of motion exercises

Open reduction with possible internal fixation (correct)

Closed reduction without fixation

Application of a splint for 8 weeks

Which technique is utilized for the reduction of a posterior elbow dislocation?

Grasp the patient's hand with fingers interlocked (correct)

Utilize a traction device on the forearm

Push upward on the patient's distal humerus

Position the patient face down

What is the recommended duration for splinting after a simple elbow dislocation?

10 to 14 days

2 to 4 weeks

3 days

5 to 7 days (correct)

Why should passive range of motion exercises be avoided in the early stages of rehabilitation for an elbow dislocation?

They may cause inflammation and swelling Signup and view all the answers

When can strengthening exercises typically commence after an elbow dislocation?

At 6 to 8 weeks Signup and view all the answers

What is the primary cause of radial head fractures?

Indirect trauma from a fall on an abducted arm Signup and view all the answers

What is a common sign of a radial head fracture?

Swelling at the lateral aspect and tenderness over the radial head Signup and view all the answers

Which movements should be avoided during the first two weeks of rehabilitation after an elbow dislocation?

Valgus stress and forced terminal extension Signup and view all the answers

What percentage of all elbow injuries do elbow dislocations constitute?

10% to 25% Signup and view all the answers

Which type of elbow dislocation is most commonly associated with fractures?

Complex elbow dislocation Signup and view all the answers

In the context of elbow dislocations, what is the 'terrible triad'?

Injuries to the coronoid process, radial head, and posterior lateral dislocation Signup and view all the answers

What is the recommended treatment for a simple posterior elbow dislocation?

Closed reduction and immobilization for 2-3 weeks Signup and view all the answers

What primarily causes posterior elbow dislocations in children under 10 years?

Falls on an outstretched hand Signup and view all the answers

Which of the following is NOT typically associated with a complex elbow dislocation?

Bursitis of the elbow Signup and view all the answers

What is the classification of simple dislocations based on the direction of the dislocated ulna?

Posterior, posteromedial, posterolateral, and direct lateral Signup and view all the answers

Which nerve injury might be associated with a complex elbow dislocation?

Median nerve injury Signup and view all the answers

What is the recommended treatment for a Type I radial head fracture?

Immobilization in a plaster cast for 3 weeks Signup and view all the answers

Which classification of radial head fractures involves a complete articular fracture with severe comminution?

Type III Signup and view all the answers

What is the main risk associated with starting physical therapy too early after a radial head fracture?

Myositis ossificans Signup and view all the answers

What indicates the need for ORIF in the treatment of a Monteggia fracture?

Redisplacement of the fracture Signup and view all the answers

In a Galeazzi fracture-dislocation, which anatomical area is primarily involved?

Distal third of the radius Signup and view all the answers

During which phase of rehabilitation for a 'both bone forearm fracture' is active and active-assisted ROM of the elbow, forearm, and wrist started?

Phase II (weeks 2–6) Signup and view all the answers

What should a patient avoid doing during Phase II of rehabilitation for a forearm fracture?

Repetitive forearm twisting Signup and view all the answers

What is the minimal time frame recommended before starting passive movement in the elbow or radio ulnar joint after a radial head fracture?

14 to 21 days Signup and view all the answers

What is a characteristic feature of complex regional pain syndrome 1 (CRPS 1)?

Severe pain out of proportion to the initial injury Signup and view all the answers

Which of the following is NOT a clinical symptom of CRPS?

Complete loss of sensation Signup and view all the answers

What is the main goal of physical therapy in treating CRPS?

To improve patient mobility while controlling pain and edema Signup and view all the answers

Which type of physical therapy technique encourages the use of the unaffected limb's reflection?

Mirror therapy Signup and view all the answers

Which treatment modality is indicated for an undisplaced fracture?

Application of a cast Signup and view all the answers

What is the typical cast position for an undisplaced fracture?

In slight palmar flexion and ulnar deviation Signup and view all the answers

What does desensitization therapy consist of?

Using stimuli of various fabrics, pressures, and temperatures Signup and view all the answers

What is the focus during the early rehabilitation phase following a fracture?

To limit pain and reduce edema in the wrist and hand Signup and view all the answers

What is the standard initial treatment for an undisplaced scaphoid fracture?

Cast immobilization Signup and view all the answers

What is the primary risk associated with fractures of the proximal pole of the scaphoid?

Avascular necrosis Signup and view all the answers

In the treatment of a minimally displaced scaphoid fracture, what follows the initial long arm thumb spica cast immobilization?

Short arm thumb spica cast Signup and view all the answers

Which imaging method is most reliable for confirming the healing of a scaphoid fracture?

Radiograph Signup and view all the answers

Which treatment is recommended for displaced or unstable scaphoid fractures?

Operative treatment Signup and view all the answers

What complication is most associated with lunate fractures?

Kienbock’s disease Signup and view all the answers

Which method is NOT commonly used in the treatment of scaphoid fractures?

Immediate active motion for the thumb Signup and view all the answers

What is a characteristic of a Bennett's fracture?

Intra-articular fracture at the base of the 1st metacarpal Signup and view all the answers

What is the typical management approach for a Smith fracture?

Concentration on regaining wrist flexion range of motion. Signup and view all the answers

What is the primary distinguishing characteristic of a Barton’s Fracture?

It is an intra-articular distal radius fracture with volar displacement. Signup and view all the answers

What is the recommended early mobilization timeframe after surgery for a wrist fracture managed with internal fixation?

1 week post-surgery. Signup and view all the answers

Which of the following correctly describes the mechanism of injury for a Radial Styloid Fracture?

Compression of the scaphoid against the styloid. Signup and view all the answers

What is a typical symptom of a Scaphoid fracture?

Pain in the anatomical snuff box. Signup and view all the answers

What is the expected range of time for regaining the majority of wrist range of motion post-operatively?

6 to 8 weeks. Signup and view all the answers

What type of wrist movements should be prioritized during rehabilitation after internal fixation?

Active and active assisted wrist exercises including extension and radial deviation. Signup and view all the answers

Which of the following statements regarding a Colles' fracture is accurate?

It is more common than a Smith fracture. Signup and view all the answers

Study Notes

Upper Limb Fractures & Dislocations

Elbow dislocations account for 10% to 25% of elbow injuries in adults; second only to shoulder dislocations.
Simple elbow dislocations involve only ligament damage without fractures.
Posterior elbow dislocations are the most common and are further categorized by the direction of the dislocated ulna (posterior, posteromedial, posterolateral, direct lateral).
Complex elbow dislocations include associated bone fractures, commonly the radial head, coronoid process of the ulna, and olecranon.
The "terrible triad" elbow dislocation damages the coronoid process, radial head, and posterior lateral elbow joint.
Nerve or blood vessel injuries are possible complications of elbow dislocations (ulnar/median neuropraxia, possible brachial artery injury).
Ulnar collateral ligament tears can accompany elbow dislocations.

Elbow Dislocation Mechanisms

In children under ten, posterior elbow dislocations (PEDs) are most frequent, often caused by falls on outstretched hands.
Forceful axial compression, valgus stress, arm abduction, and forearm supination contribute to posterior dislocations.
Anterior dislocations result from direct force to the posterior forearm with a flexed elbow.

Elbow Dislocation Treatment

Simple posterior dislocations typically involve closed reduction under sedation, followed by plaster cast or posterior splint immobilization at 90 degrees for 2-3 weeks.
Early active range of motion exercises are important.
Complex or unstable elbow dislocations, with severe soft tissue or bony entrapment, require open reduction with or without internal fixation, usually requiring ulnar collateral ligament repair.

Posterior Elbow Reduction Techniques

Palm-palm technique: Examiner grasps patient's hand with palms touching and interlocked.
Position examiner's elbow in patient's antecubital fossa.
Distract dislocation by pushing downward on patient's distal humerus.
Pull dislocated elbow posteriorly back into anatomical position.

Elbow Rehabilitation

Extended casting and prolonged immobilization may cause post-traumatic stiffness.
Early active range of motion (ROM) is crucial for simple dislocations.
Soft tissue swelling management involves compressive dressings and ice.
Elbow brace use is typically from 5-7 days extending to up to 3 to 5 months increasing ROM by 10-15 degrees weekly.
Passive ROM, valgus stress, abduction, external rotation, and forced terminal extension should be avoided for two weeks post injury to allow for proper healing.
Strengthening and resistive exercises are not prescribed for two weeks and can be initiated after 6-8 weeks, allowing the ligamenous structures time to heal.

Radial Head Fracture

Occur as a result of falls on an outstretched arm with minimal to moderate elbow flexion (0-80 degrees).
The history is often a fall onto an outstretched arm.
An uncommon but possible mechanism of injury is a direct blow to the elbow.
The fracture occurs when the radial head is forcefully pressed against the capitulum of the humerus.
Often accompanied by elbow dislocation.
Commonly results in a 10-15 degree limit in ROM, maximal tenderness at the radial head.
The most common complication is limited range of motion.

Radial Head Fracture treatment

Type I: Immobilization in a plaster cast for 3 weeks.
Type II: Open reduction and internal fixation (ORIF) and immobilization in a plaster cast for 2 weeks.
Type III: ORIF or excision of the radial head and immobilization in a plaster cast for 2 weeks.
Type IV: Radial head resection or replacement.
No passive movement for the elbow or radio-ulnar joint for 14 to 21 days post-injury to reduce myositis osficans risk. Active and active-assisted ROM exercises should begin early.

Forearm Bone Shaft Fracture (Monteggia and Galeazzi)

Monteggia: Fracture of the upper third of the ulna with anterior displacement of the upper ulna fragment and anterior dislocation of the radius. Requires ORIF or it will redisplace.
Galeazzi: Fracture of the distal one-third of the radius with dislocation or subluxation of the inferior radioulnar joint. Conservative treatment may cause redisplacement. ORIF may be necessary.

Both Bone Forearm Fracture Rehabilitation

Phase 1(0-2 weeks): Immobilization in a splint, Sutures or staples removed at week two, Elevation of extremity encouraged, Edema control, ROM of fingers
Phase 2(2-6 weeks): Active and active-assisted ROM of elbow, forearm, and wrist, No repetitive forearm twisting
Phase 3(6+ weeks): Lifting and twisting restrictions lifted once union is achieved, Work on regaining pre-operative motion, Communication with surgeon is critical.

Distal Radial Fractures

Colle's fracture: Extra-articular fracture of the distal radius, typically affects older adults and is linked to falls on dorsiflexed wrists. Results in a Dinner Fork deformity.
Smith fracture: Fracture of the distal radius with palmar displacement. The typical deformity is a Garden Spade deformity
Barton's fracture: Intra-articular distal radius fracture with volar displacement. The typical deformity looks like a Smith fracture.
Radial styloid fracture: Results from compression of the scaphoid against the styloid process.

Carpal Bone Fractures (Scaphoid)

Scaphoid fractures: 50-80% of all carpal fractures, commonly caused by falls on outstretched hands.
Deep, dull ache typically in the radial part of the wrist, with pain elicited by gripping and pinching. Swelling, bruising, and possible fullness in the anatomical snuffbox may also be present.
Proximal portion has no direct blood supply.
Distal pole fracture heals in 2 to 3 weeks, whereas waist and proximal fractures may require 8 to 12 weeks immobilization.
Non-displaced scaphoid fractures are typically treated with cast immobilization, whereas minimally displaced fractures may need closed reduction, followed by long arm thumb spica casts or short arm thumb spica casts. These may be maintained for 2-4 weeks before progressing to removal of cast or use of a thumb spica splint if union is delayed. Displaced fractures require operative intervention.

Lunate Fracture

Typically occurs via a fall onto an outstretched hand (FOOSH).
Risk of avascular necrosis due to its blood supply entering at distal / proximal fracture fragment
Tenderness along the 3rd metacarpal, elicited by axial compression, may indicate injury, but is not confirmed by radiography.
Palpate the area just distal to the center of the distal radius. Wrist flexion exacerbates tenderness by pressing the lunate against the examiner's finger
Non-displaced: Short arm cast for 4-6 weeks
Displaced: Surgical fixation

Metacarpal Fractures (Bennett's & Boxer's)

Bennett's: intra-articular base of the first metacarpal with dislocation; triangular or Y-shaped fracture (Rolando).
Boxer's: fracture of distal 4th or 5th metacarpal from striking a closed fist, resulting in a need for initial immobilization.

Metacarpal Fracture Treatment

Non-displaced fractures: Immobilization using splints, casts, or buddy taping (taping little finger to the ring finger).
Significantly displaced or misaligned fractures: Open reduction and internal fixation (ORIF) with wires and screws.
All splint programs for metacarpal and phalangeal fractures should position joints in flexion to avoid extension contractures
Thumb metacarpophalangeal joints should be positioned in flexion

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Test your knowledge on the management and rehabilitation of elbow dislocations with this quiz. Covering initial approaches, reduction techniques, and rehabilitation phases, this quiz is essential for understanding elbow injury treatment. Perfect for medical students and professionals alike.