![\"\"](\"\/wp-content\/images\/part1\/oss.elbow.jpg\")
<\/a><\/p>\n <\/p>\n If patient can fully extend and lock elbow and pronate\/supinate: pt does not have fracture with good sens\/spec (<\/p>\n Docherty MA et al:<\/p>\n Can elbow extension be used as a test of clinically<\/p>\n significant injury?<\/p>\n South Med J <\/em>95:539, 2002)<\/p>\n <\/p>\n <\/p>\n <\/p>\n <\/p>\n <\/p>\n <\/p>\n Carrying Angle-angle between middle 1\/3 of humerus and middle 1\/3 of ulna should be \u226412\u00ba<\/p>\n <\/p>\n Posterior long arm splint:\u00a0 axilla to just proximal to mcp-encircle at least \u00be of the arm c elbow in 90\u00ba flexion<\/p>\n <\/p>\n Transcondylar fracture-always associated c posterior dislocation of the radius or the ulna<\/p>\n <\/p>\n Tennis Elbow-tear of the extensor tendons<\/p>\n radial head displaces out of the annular ligament<\/p>\n acute interposition of the annular ligament into the radiocapitellar joint, is a common injury and accounts for 22% of all upper extremity injuries seen in pediatric ED’s in children under 5 years of age.<\/p>\n Squeeze head, extend elbow, supinate forearm then flec at elbow if it doesn\u0092t work, try hyperpronation (Macias CG Radial head subluxation Acad Emerg Med\u00a0 2000; 7(2): 207-8, McDonald J, et al.\u00a0 Radial head subluxation: comparing two methods of reduction Acad Emerg Med 1999; (7):715-8)<\/p>\n can present with the complaint after 30 minutes or 6 months<\/p>\n 4 Presentations<\/p>\n Pt has had it for 6 months<\/p>\n Febrile patient with red, hot, swollen elbow<\/p>\n Same as number two, but patient has a history of gout<\/p>\n Swelling After trauma<\/p>\n <\/p>\n Aspirate all of them, it gives symptomatic relief and makes the patient feel better about treatment<\/p>\n Only send to lab if question of infection<\/p>\n Cell count>2000 WBCs sensitive and specific<\/p>\n If <1000 then infection is unlikely<\/p>\n Send for crystals and culture<\/p>\n If nonseptic, can inject 20 – 40 mg of steroids<\/p>\n warn patient that fluid may reaccumulate in 3-4 days<\/p>\n If septic, use penicillinae resistant penicillin (oxacillin) or 1st generation cephalosporin<\/p>\n If the patient appears toxic, admit<\/p>\n If diagnosis is unclear, treat as if septic and have patient follow up for culture results, do not give steroids<\/p>\n Posterior takes out the ulna, reduce c Stimson\u0092s and immobilize the elbow in 90 of flexion.<\/p>\n Posterior is the most common.<\/p>\n Better means of reduction. Put hands on humerus with elbow flexed at 90. Put boths thumbs on olecranon and rotate it back into place.<\/p>\n <\/p>\n Anteror<\/p>\n Splint and get emergent consult<\/p>\n Check median nerve and brachial artery.<\/p>\n <\/p>\n <\/p>\n Humeral fxs can box median nerves or brachial artery<\/p>\n Humerus fractures can be placed in sugar tong splint.<\/p>\n X-ray shoulder, elbow and AP\/Lat of humerus<\/p>\n Proximal Humerus-greater and lesser tuberosity, surgical neck, anatomic neck<\/p>\n If proximal humerus fracture, should see on shoulder series.\u00a0 Also get AP in internal rotation and Axillary view.\u00a0 Can see pseudo-subluxation 2\u00ba to blood in joint<\/p>\n Angle between head and shaft is normally 135\u00ba, if less than 90 or greater than 180, this is bad<\/p>\n Proximal humerus c <45 angulation, <50 displacement, <1 cm distraction, can put in sling and send to clinic<\/p>\n <\/p>\n <\/p>\n <\/p>\n ELBOW<\/strong>Elbow radiographs are notoriously poor in directly detecting fractures.\u00a0 Indirect signs such as fat pads and bony misalignments are often the only suggestions of an injury.\u00a0 The normal radiographic anatomy of the elbow is seen in Figures 9 and 10.\u00a0 A fat pad is a collection of fat tissue adjacent to the elbow joint capsule, found both anteriorly and posteriorly.\u00a0 These fat pads can become displaced by an intra-articular effusion such as a hemarthrosis.\u00a0 A small, lucent anterior fat pad lying anterior to the distal humerus can be normal.\u00a0 This anterior fat pad is considered abnormal, however, when it becomes displaced and elevated (called a \u0093sail sign\u0094).\u00a0 In contrast, the presence of any posterior fat pad, regardless of size and displacement, is pathological. In addition to fat pads, the other indirect finding to examine in the elbow is bony alignment.\u00a0 The first alignment is the radiocapitellate line.\u00a0 On both the AP and lateral views, a longitudinal line drawn through the midshaft of the radius should bisect the capitellum.\u00a0 Any misalignment suggests a radial head dislocation.\u00a0 The second line is the anterior humeral line.\u00a0 On a lateral view, a longitudinal line drawn along the anterior aspect of the humerus should bisect the capitellum.\u00a0 Extremely important to examine especially in the pediatric population, an abnormal anterior humeral alignment suggests a supracondylar fracture.Figure 9.\u00a0 AP radiograph and diagram of a normal right elbow In the elbow, a radial head \u0093D\u0094islocation, which often occurs in association with a proximal ulna fracture, is diagnosed by an abnormal radiocapitellate alignment.\u00a0 This injury will be discussed later in the Monteggia fracture-dislocation section. The primary \u0093O\u0094ccult fracture missed in the adult elbow is a radial head fracture.\u00a0 In the Freeds and Shields study, elbow fractures ranked the second highest in terms of the \u0093miss rate\u0094 at 10.8%.\u00a0 In adults, radial head fractures comprised the majority of these overlooked fractures.\u00a0 Radiographic findings can be extremely subtle.\u00a0 Over 80% of elbow fractures had an associated abnormal fat pad and over 40% had a fat pad sign as the only indicator of a fracture (10).\u00a0 Figure 11 demonstrates a small nondisplaced radial head fracture with an easily overlooked cortical break and the presence of both a large anterior fat pad sign (\u0093sail sign\u0094) and posterior fat pad.Figure 11.\u00a0 Radial head fracture (lateral view)<\/strong><\/p>\n (EMEDHOME.COM)<\/p>\n <\/p>\n |\u00a0\u00a0 \u00a0\u00a0 |\u00a0\u00a0 \u00a0\u00a0 |<\/p>\n","protected":false},"excerpt":{"rendered":" Array<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[7,17],"tags":[],"yoast_head":"\n<\/a><\/p>\n<\/a><\/p>\n<\/span>Soft Tissue Injuries\/Dislocation<\/span><\/h3>\n
Nursemaid\u0092s Elbow<\/h4>\n
Olecranon Bursitis<\/h4>\n
<\/span>Elbow Dislocations<\/span><\/h3>\n
<\/span>Humerus<\/span><\/h3>\n
<\/a>\u00a0 <\/a> Figure 10.\u00a0 Lateral radiograph and diagram of normal right elbow<\/strong><\/p>\n<\/a>\u00a0 <\/a><\/p>\n<\/a>\u00a0\u00a0\u00a0\u00a0\u00a0 <\/a> The \u0093H\u0094alf injury in the elbow refers to a Monteggia fracture-dislocation pattern, which is a proximal ulna diaphyseal fracture associated with a radial head dislocation (Figure 12).\u00a0 When the former is radiographically visualized, a careful search for the latter must be performed by examining the radiocapitellate alignment.\u00a0 Monteggia fractures are initially missed approximately 50% of the time in the pediatric population (14).\u00a0 Always beware of a discharge diagnosis of an isolated proximal ulna fracture.\u00a0 A complication from a delayed diagnosis of the associated radial head dislocation includes paralysis of the posterior interosseous nerve, which normally wraps around the radial neck.Figure 12.\u00a0 Monteggia fracture-dislocation of elbow (lateral view)<\/strong> <\/a> <\/a><\/p>\n