Elbow Disorders

DISLOCATIONS

Elbow Dislocations

• Usually posterior
• Neuropraxia in 20% (ulnar & median nerves - usually AIN)
• Usually stable once reduced, since bony stability is good.
• If instability occurs in 30 deg of flexion, then place forearm in maximum pronation (which tensions lateral soft tissues crossing the elbow).
• Main problem is stiffness, thus go for early ROM
• Complex injury = with associated fractures:
  1. Radial head fracture causing instability then replace radial head (silastic or titanium implant)
  2. MCL is always damaged to variable degrees. May be fracture of Medial epicondyle = ORIF
  3. Coronoid fractures:
     • due to avulsion by brachialis when elbow is hyperextened
     • Type I: avulsion of the tip of the coronoid process  - closed reduction and early motion
     • Type II: involving less than 50% of the process - closed reduction and early motion
     • Type III: involving > 50% of process - = high redislocation rate & requires ORIF - there may be an associated valgus instability since MCL inserts onto the fracture fragment. 
  4. Terrible Triad = radial head + coronoid + MCL 

Radial Head Dislocation

Congenital:

• Posterior
• Often have little functional deficit
• Capitellum is dysplastic
• Therefore relocation is not successful
• Develop OA of ulnohumeral joint in adulthood

Traumatic

• Reduce
• Look very carefully for Monteggia fracture of ulna
• If unstable - reconstruct annular ligament (may need triceps sling)

CONTRACTURES

1. Trauma
2. Arthritis
3. Miscellaneous - infection, burns, haemophilia
4. Arthrogryposis