ORTHOPEDICSElbow Injuries
OLECRANONFRACTURES
■ For a nondisplaced olecranon fracture, stabilize with a posterior splint. For
an olecranon fracture with >2 mm displacement, obtain orthopedic con-
sult for ORIF.
■ Ulnar nerve injuries are sometimes seen.
DISTALHUMERUSCONDYLARFRACTURES
DIAGNOSIS
Distal humerus condylar fracture usually involves both the articular (trochlea,
capitellum) and the nonarticular (epicondyle) surfaces. Lateral condylar frac-
tures are much more common than medial, which are limited to children.
TREATMENT
■ For nondisplaced condylar fractures, stabilize with a posterior arm splint.
■ Condylar fractures with >3 mm displacement will need surgical fixation.
COMPLICATIONS
Nonunion, ulnar nerve palsy, avascular necrosis, compartment syndrome
ELBOWARTICULARSURFACEFRACTURES
DIAGNOSIS
Trochlea and capitellum fractures
TREATMENT
■ For nondisplaced articular surface fractures, stabilize with a posterior arm
splint.
■ Articular surface fractures with even minimal displacement require ortho-
pedic consult.
COMPLICATIONS
Associated with posterior elbow dislocation
DISTALHUMERUSEPICONDYLARFRACTURES
MEDIALEPICONDYLARFRACTURE
■ Common in children and adolescents
■ Occurs from repeated valgus stress (little leaguer’s elbow), posterior elbow
dislocation, or a direct trauma
TREATMENT
■ Nondisplaced medial epicondylar fractures can be stabilized with a poste-
rior splint with the elbow in 90° flexion and the forearm in pronation.
■ Fractures with >3–5 mm displacement or intra-articular fractures require
orthopedic consult.
COMPLICATIONS
60% of epicondylar fractures will have an associated ulnar nerve injury.
In all views, the axis of the
proximal radius should pass
through the center of the
capitellum if it is not
dislocated.