Symptoms and Treatment of Elbow Injuries:

Acute elbow injuries include fractures, dislocations and ligament or tendon ruptures.

Fractures

As the complication rate for elbow fractures is higher than with fractures near other joints, it is essential that fractures in this region are recognized and treated early and aggressively. Unstable fractures, usually those associated with displacement, should be referred early for orthopedic management. When the articular or cortical surface has less than 2 mm (0.1 in.) of vertical or horizontal displacement, the fracture can be regarded as stable and treated conservatively. The most common complication of elbow fractures is stiffness, particularly loss of terminal extension. Prompt diagnosis and treatment that includes an early rehabilitation program can help avoid this outcome. Thus, treatment of elbow fractures must be aggressive. Surgically stabilizing an adult elbow fracture allows early commencement of a post-operative range of motion program. A stable fracture that involves no significant comminution, displacement or angulation may be treated conservatively. In adults, immobilizing the arm for a few days, even up to a week, is generally well tolerated. Then the arm should be placed in a removal splint and early motion commenced. The fracture should then be protected for six to eight weeks, with early and frequent radiographic checks to ensure the reduction stays anatomical.

• The other main complication of elbow fractures, particularly in high energy injuries, is heterotopic ossification.
• Traumatized elbows that are forcefully or passively manipulated may also be at greater risk of this complication.
• Therefore, gentle, active assisted range of motion exercises are preferred. Heterotopic bone formation has also been associated with elbow fractures treated surgically between one and five days after injury or treated with multiple surgical procedures.
• Thus, surgery should be performed in the first 24 hours after injury or after five to seven days

Types of Fracture:

• Supracondylar Fracture
• Olecranon Fractures
• Radial Head Fracture

1.      Supracondylar Fracture

Supracondylar fractures are more common around the age of 12 than in adults. They often occur from a fall on an outstretched arm, either from a height or a bicycle. Because they are rotationally unstable and have a high rate of neurovascular complications, these fractures should be regarded as an orthopedic emergency. For fractures that are unstable, displaced or cannot be reduced without jeopardizing the blood supply, the treatment of choice is closed reduction in the operating room under general anesthesia. Stiffness is typically not a problem in children recovering from fractures.

2.     Olecranon Fractures

Olecranon fractures occur from a fall onto an out-stretched hand or from direct trauma to the elbow. If the fracture is non-displaced and stable, the patient should be able to extend the arm against gravity. Treatment consists of immobilizing the arm for two to three weeks in a posterior splint, and then in a removable splint and a range of motion program commenced. If the patient is unable to extend the elbow against gravity or if radiographs show significant displacement, open reduction with internal fixation by tension-band wiring is preferred. Early motion is started within one week of surgery.

3.     Radial Head Fracture

The most common fracture around the elbow in athletes is the radial head fracture, almost always resulting from a fall onto an outstretched hand. Most radial head fractures are minimally displaced or non-displaced and are very difficult to see on radiographs. Sometimes the only clue is the fat pad sign, which appears as a triangular radiolucency just in front of the elbow joint.

Posterior Dislocation

The most serious acute injury to the elbow is posterior dislocation of the elbow. This can occur either in contact sports or when falling from a height such as while pole vaulting. There is often an associated fracture of the coronoid process or radial head. The usual mechanism is a posterolateral rotatory force resulting from a fall on an outstretched hand with the shoulder abducted, axial compression, forearm in supination and then forced flexion of the elbow. The major complication of posterior dislocation of the elbow is impairment of the vascular supply to the forearm. Assessment of pulses distal to the dislocation is essential. If pulses are absent, reduction of the dislocation is required urgently. Reduction is usually relatively easy. The elbow usually reduces with a pronounced clunk. If vascular impairment persists after reduction, urgent surgical intervention is required.

• Long-term loss of extension is frequently a problem following elbow dislocation. Immediately active mobilization under supervision has been shown to result in less restriction of elbow extension with no apparent increase in instability are able to return to sport relatively quickly after an accelerated rehabilitation program.
• Verrall described three cases of stable dislocations in professional footballers who returned to sport after 13, 21 and seven days respectively with no further complications.
• Joint mobilization may be required as part of the treatment. Surrounding muscles should also be strengthened.
• Elbow stability taping should be applied on return to sport.
• Elbow dislocations in directions other than posterior occur occasionally. These are often associated severe ligamentous disruption and patients should referred to an orthopedic surgeon immediately.
• Some patients may develop chronic instability the elbow following an acute dislocation. This is classically posterior lateral instability with a positive pivot shift test.
• If symptoms are unacceptable, then a reconstruction of the lateral ulnar collateral ligament may be indicated.

Symptoms of Acute Elbow Injuries:

• Acute rupture of the MCL may occur in a previously damaged ligament or in a normal ligament subjected to extreme valgus stress, for example, elbow dislocation.
• The degree of instability should be assessed by applying valgus stress to the elbow at 30 of flexion.
• If complete disruption is present with associated instability, surgical repair of the ligament is required. Incomplete tears should be treated with protection in a brace and muscle strengthening for a period of three to six weeks.

Treatment of Acute Elbow Injuries:

• Acute avulsion of the biceps or triceps tendons from their insertions is a rare condition.
• Rupture of the biceps tendon insertion occurs predominantly in strength activities (e.g. weightlifting). Rupture of the triceps tendon occurs most commonly with excessive deceleration force, such as occurs during a fall or by a direct blow to the posterior aspect of the elbow.
• Partial and complete triceps ruptures are seen in American National Football League linemen. Partial tears tend to heal well without surgery.
• Acute complete ruptures at the insertion of either of these tendons should be treated surgically.