Orthopaedic Emergencies 287INJURIES TO THE ELBOW AND FOREARM2 Examine for local tenderness, swelling and loss of active elbow extension.
3 Request an X-ray to confirm the diagnosis and to delineate the degree of
fracture displacement, angulation or comminution.
(i) Anterior dislocation of the elbow may accompany a displaced
olecranon fracture.
MANAGEMENT1 Give the patient analgesia and a sling, and refer immediately to the ortho-
paedic team for operative reduction if there is displacement of the olecranon,
or an associated anterior dislocation of the elbow.
2 Treat an undisplaced hairline fracture with a long-arm plaster, with the
elbow f lexed, and review at the next fracture clinic.
Fractures of the radial head
DIAGNOSIS
1 These fractures are caused by direct violence or by indirect force, such as
falling on to the outstretched hand, when the radius is driven proximally
against the capitellum.
2 There is localized pain and tenderness over the radial head, discomfort on
supination of the forearm and a loss of full elbow extension.
3 Unfortunately, this injury is commonly missed, usually because it is not
t hought of or because it is not seen on X-ray.
4 Request an X-ray of the elbow.
(i) It may be difficult or impossible to see the fracture, but look for
corroborating evidence of a posterior fat-pad sign (see Fig. 9.1).
(ii) If there is doubt, ask specifically for additional radial head views.
MANAGEMENT1 Place a non-displaced fracture in a collar and cuff, and refer the patient to the
next fracture clinic.
2 Use a plaster elbow backslab for comfort and protection if there is severe
localized pain.
3 Refer the patient directly to the orthopaedic team if the radial head is severely
comminuted or grossly displaced, for consideration of operative management.
Fractures of the radial and ulnar shafts
These two bones act as a unit, attached proximally at the radial head by the
annular ligament, throughout their length by the interosseous membrane and
distally by the radio-ulnar ligaments.
It is rare to fracture one bone in isolation and, as in humeral shaft fractures, it is
vital to X-ray the joints above and below (here, the elbow and wrist).