Podcast
Questions and Answers
Elbow dislocations constitute ___% to ___% of all injuries to the elbow.
Elbow dislocations constitute ___% to ___% of all injuries to the elbow.
10, 25
Among injuries to the upper extremity, dislocation of the elbow is second only to dislocation of the ___.
Among injuries to the upper extremity, dislocation of the elbow is second only to dislocation of the ___.
shoulder
Simple dislocations of the elbow are those in which the injury is only ___ without any associated fractures.
Simple dislocations of the elbow are those in which the injury is only ___ without any associated fractures.
ligamentous
The most common type of elbow dislocation is ___ dislocation.
The most common type of elbow dislocation is ___ dislocation.
Signup and view all the answers
Complex elbow dislocations are those that include associated ___.
Complex elbow dislocations are those that include associated ___.
Signup and view all the answers
The 'terrible triad' elbow dislocation includes injuries to the coronoid process, radial head, and posterior ___ dislocation.
The 'terrible triad' elbow dislocation includes injuries to the coronoid process, radial head, and posterior ___ dislocation.
Signup and view all the answers
In children under 10 years, PEDs are the most common type of joint ___.
In children under 10 years, PEDs are the most common type of joint ___.
Signup and view all the answers
Simple posterior dislocation treatment includes closed reduction, fixation in plaster cast or posterior splint with the elbow at ___ degrees.
Simple posterior dislocation treatment includes closed reduction, fixation in plaster cast or posterior splint with the elbow at ___ degrees.
Signup and view all the answers
Early mobilization after surgery can begin approximately 1 week after __________.
Early mobilization after surgery can begin approximately 1 week after __________.
Signup and view all the answers
A __________ fracture occurs at the lower end of the radius with anterior displacement of the distal fragment.
A __________ fracture occurs at the lower end of the radius with anterior displacement of the distal fragment.
Signup and view all the answers
The two most common stretches to increase range of motion (ROM) are wrist __________ and flexion.
The two most common stretches to increase range of motion (ROM) are wrist __________ and flexion.
Signup and view all the answers
Barton’s fracture is an intra-articular distal radius fracture with __________ displacement.
Barton’s fracture is an intra-articular distal radius fracture with __________ displacement.
Signup and view all the answers
A radial styloid fracture is also known as a __________ fracture due to its mechanism of injury.
A radial styloid fracture is also known as a __________ fracture due to its mechanism of injury.
Signup and view all the answers
Complex regional pain syndrome (CRPS) typically develops after an injury, a surgery, a stroke or a ______.
Complex regional pain syndrome (CRPS) typically develops after an injury, a surgery, a stroke or a ______.
Signup and view all the answers
Type 1 complex regional pain syndrome (CRPS 1) was formerly known as ______.
Type 1 complex regional pain syndrome (CRPS 1) was formerly known as ______.
Signup and view all the answers
CRPS 1 is characterized by pain, swelling, and ______ dysfunction of an extremity.
CRPS 1 is characterized by pain, swelling, and ______ dysfunction of an extremity.
Signup and view all the answers
The treatment for patients with CRPS depends on early recognition and early intervention of physical therapy besides ______ agents and nerve blocks.
The treatment for patients with CRPS depends on early recognition and early intervention of physical therapy besides ______ agents and nerve blocks.
Signup and view all the answers
Mirror therapy involves placing both hands into a box with a ______ separating the two compartments.
Mirror therapy involves placing both hands into a box with a ______ separating the two compartments.
Signup and view all the answers
An undisplaced fracture may be treated with a ______ alone.
An undisplaced fracture may be treated with a ______ alone.
Signup and view all the answers
Significant angulation and deformity may require an open reduction and ______ fixation.
Significant angulation and deformity may require an open reduction and ______ fixation.
Signup and view all the answers
The focus in the beginning of rehabilitation is to mobilize the ______, which is indicated approximately 7-8 weeks post fracture.
The focus in the beginning of rehabilitation is to mobilize the ______, which is indicated approximately 7-8 weeks post fracture.
Signup and view all the answers
Complex or unstable elbow dislocation often requires open reduction with or without internal ______.
Complex or unstable elbow dislocation often requires open reduction with or without internal ______.
Signup and view all the answers
The palm-palm technique involves grasping the patient's hand with palms together and ______ interlocked.
The palm-palm technique involves grasping the patient's hand with palms together and ______ interlocked.
Signup and view all the answers
For simple elbow dislocations, early active ______ is crucial to prevent post-traumatic stiffness.
For simple elbow dislocations, early active ______ is crucial to prevent post-traumatic stiffness.
Signup and view all the answers
Soft tissue swelling can be controlled with compressive dressings and application of ______.
Soft tissue swelling can be controlled with compressive dressings and application of ______.
Signup and view all the answers
Radial head fractures usually occur as a result of indirect ______, mostly from a fall on an abducted arm.
Radial head fractures usually occur as a result of indirect ______, mostly from a fall on an abducted arm.
Signup and view all the answers
During the rehabilitation process, passive ROM should be avoided because it increases swelling and ______.
During the rehabilitation process, passive ROM should be avoided because it increases swelling and ______.
Signup and view all the answers
Maximal tenderness is often felt over the radial ______ in cases of radial head fractures.
Maximal tenderness is often felt over the radial ______ in cases of radial head fractures.
Signup and view all the answers
Elbow flexion typically returns first, with full flexion restored by ______ to 12 weeks.
Elbow flexion typically returns first, with full flexion restored by ______ to 12 weeks.
Signup and view all the answers
Colle's fracture commonly affects older individuals, particularly due to the prevalence of ______.
Colle's fracture commonly affects older individuals, particularly due to the prevalence of ______.
Signup and view all the answers
A typical deformity of a Colle's fracture is known as the ______ fork.
A typical deformity of a Colle's fracture is known as the ______ fork.
Signup and view all the answers
The most common early complication of a Colles fracture is ______ artery injury.
The most common early complication of a Colles fracture is ______ artery injury.
Signup and view all the answers
Type I fractures require ______ in a plaster cast for 3 weeks.
Type I fractures require ______ in a plaster cast for 3 weeks.
Signup and view all the answers
The late complication of Colles fracture that results in chronic pain is termed ______ regional pain syndrome.
The late complication of Colles fracture that results in chronic pain is termed ______ regional pain syndrome.
Signup and view all the answers
Malunion in a Colles' fracture can lead to permanent loss of full wrist ______.
Malunion in a Colles' fracture can lead to permanent loss of full wrist ______.
Signup and view all the answers
A Type IV radial head fracture is associated with an elbow ______.
A Type IV radial head fracture is associated with an elbow ______.
Signup and view all the answers
Colle's fracture results from a fall on a ______ flexed wrist.
Colle's fracture results from a fall on a ______ flexed wrist.
Signup and view all the answers
Monteggia fracture involves an anterior displacement of the upper fragment of the ______.
Monteggia fracture involves an anterior displacement of the upper fragment of the ______.
Signup and view all the answers
Galeazzi fracture includes a fracture of the distal 1/3rd of the ______.
Galeazzi fracture includes a fracture of the distal 1/3rd of the ______.
Signup and view all the answers
Complications from Colles fracture can include joint stiffness and ______.
Complications from Colles fracture can include joint stiffness and ______.
Signup and view all the answers
Phase I rehabilitation begins with placing the patient in a ______.
Phase I rehabilitation begins with placing the patient in a ______.
Signup and view all the answers
The distal fragment in a Colles’ fracture may heal when displaced ______.
The distal fragment in a Colles’ fracture may heal when displaced ______.
Signup and view all the answers
In Phase II rehabilitation, patients engage in active and active-assisted ROM of the elbow, forearm, and ______.
In Phase II rehabilitation, patients engage in active and active-assisted ROM of the elbow, forearm, and ______.
Signup and view all the answers
After reduction and immobilization, if the fracture is redisplaced, it may require ______.
After reduction and immobilization, if the fracture is redisplaced, it may require ______.
Signup and view all the answers
The Mason classification includes Type III fractures, which are characterized by complete articular fractures with severe ______.
The Mason classification includes Type III fractures, which are characterized by complete articular fractures with severe ______.
Signup and view all the answers
Study Notes
Fractures & Dislocations of the Upper Limb
- Elbow dislocations constitute 10% to 25% of all elbow injuries. Dislocation of the shoulder is the most common injury to the upper extremity in adults.
- Elbow dislocations are categorized into simple and complex patterns.
- Simple dislocations involve only ligament damage without bone fractures.
- Posterior dislocations are the most common type. Subtypes are further categorized by the direction of the dislocated ulna (posterior, posteromedial, posterolateral, or lateral).
- Complex dislocations involve associated fractures, such as of the radial head, coronoid process of the ulna, or olecranon. The "terrible triad" describes an elbow dislocation with injuries to the coronoid process, radial head, and posterior lateral dislocation of the elbow joint. Nerve or blood vessel injury is a possible complication.
- In children under 10, posterior dislocations are most common (PEDs).
Mechanism of Injury
- PEDs are most commonly caused by falling on an outstretched hand or elbow.
- Axial compression, valgus stress, arm abduction, and forearm supination can result in posterior dislocations.
- Anterior dislocations result from direct force to the posterior forearm with the elbow flexed (relatively rare).
Treatment
- Simple posterior dislocations are treated with closed reduction under sedation and fixation with a plaster cast or posterior splint at a 90-degree elbow angle for 2-3 weeks. Active range-of-motion exercises should also begin promptly.
- Complex or unstable dislocations, severe soft tissue injuries, or bony entrapment require open reduction with or without internal fixation and often ulnar collateral repair.
Reduction Techniques
- Palm-palm technique: Grasp patient's hand palm-to-palm, interlocked fingers. Position examiner's elbow in the patient's antecubital fossa. Apply downward pressure on the patient's distal humerus with the examiner's elbow. Pull the posteriorly dislocated elbow back into anatomical position.
Rehabilitation Considerations
- Extended casting and prolonged immobilization should be avoided to prevent post-traumatic stiffness.
- Early active range of motion (ROM) is critical for simple dislocations.
- Splinting for 5-7 days allows for soft tissue rest, while compressive dressings and ice can manage swelling.
- A hinged elbow brace (30-90 degrees) is applied from day 5-7, followed by active ROM.
- Active ROM enhances muscle activation, stability, and compression across the joint and is gradually increased (10-15 degrees per week) within the hinged brace.
Other Considerations following Elbow Dislocation
- Avoid passive ROM, valgus stress, abduction, and external rotation for up to 2 weeks after dislocation to avoid increasing swelling and/or inflammation and disrupting MCL healing leading to instability or recurrent dislocation.
- Avoid strengthening or resistive exercises during the initial healing phase.
- Strengthening exercises can resume at 6-8 weeks.
- Elbow flexion usually returns first (6-12 weeks), followed by extension (3-5 more weeks).
Radial Head Fracture
- Most radial head fractures are caused by indirect trauma (a fall on an outstretched arm).
- A direct blow to the elbow can cause a radial head fracture but is much less common.
- Falling with the arm abducted and the elbow slightly flexed (0-80 degrees) produces a valgus pronation stress and the radial head is forcibly pushed against the capitula of the humerus Typical presentations are pain, swelling at the lateral aspect of the elbow, limited ROM, and maximal tenderness over the radial head.
- Common complications that can arise are limited ROM (10-15 degrees)
- Treatment depends on the severity of the fracture. Undisplaced fractures are treated with a cast. ORIF (Open Reduction Internal Fixation) or excision and cast for more severe fractures, and possibly radial head replacement.
Forearm Bone Shaft Fractures
-
Monteggia fractures involve a fracture of the upper third of the ulna with anterior displacement of the upper ulna fragment and anterior dislocation of the radius.
-
Often require ORIF.
-
Galeazzi fractures involve a fracture of the distal one third of the radius with dislocation or subluxation of the distal radioulnar joint.
-
Often, require ORIF.
Both Bone Forearm Fracture Rehabilitation
- Phase I (weeks 0-2): Protect surgical incisions, elevate extremity, edema control, and finger ROM exercises.
- Phase II (weeks 2-6): Active and active-assisted ROM of elbow, forearm, and wrist. Avoid repetitive forearm twisting.
- Phase III (weeks 6+): Lifting and twisting restrictions may be removed, once union has been achieved. Work on regaining pre-injury motion.
Distal Radial Fractures
- Colle's fractures are a common type of distal radius fracture. They frequently occur in older people due to falling on an outstretched hand when the wrist is dorsiflexed (extended). The result is a typical "dinner fork" deformity.
- Smith's fractures involve anterior displacement of the distal fragment and are the opposite of Colles fractures (fall on a palmar-flexed wrist). A common deformity is a "garden spade" deformity.
- Barton's fractures are intra-articular fractures of the distal radius with volar (palmar) displacement, and appear similar to Smith's fractures. ORIF management is common.
- Radial styloid fractures result from compressive forces on the scaphoid against the styloid. Non-displaced fractures are managed with cast immobilization. Displaced fractures necessitate surgical fixation.
Complications
- Early complications of Colles' fractures can include radial artery injury, carpal tunnel syndrome, and extensor pollicis longus injury.
- Late complications include malunion, joint stiffness, Volkmann ischemic contracture, osteoarthritis, and Sudeck's osteodystrophy (CRPS).
Reflex Sympathetic Dystrophy (RSD)
- CRPS is a chronic pain syndrome which typically develops after an injury or surgery. Pain, swelling, and vasomotor dysfunction are common symptoms.
- The exact cause of RSD is unknown but peripheral and central mechanisms may play a role in sympathetic dysfunction.
Treatment Summary
- Treatment of fractures and dislocations focuses on restoring anatomical alignment and providing adequate stabilization and support during recovery.
- Cast immobilization, ORIF, external fixation, or a combination of these methods may be necessary to ensure complete healing.
- Physical therapy is essential to regain range of motion, muscle strength, and functional abilities.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
Explore the intricacies of elbow and shoulder dislocations in this quiz. Learn about the mechanisms of injury, types of dislocations, and associated complications. Perfect for medical students and professionals looking to enhance their understanding of upper limb injuries.
