Traumatic Elbow Injuries: What the Orthopedic Surgeon Wants to Know

Abstract

Traumatic elbow injuries are commonly encountered in the emergency department setting, but their complexity and clinical significance often go unrecognized at the initial evaluation. Initial imaging in patients with elbow trauma should not only help identify major injuries that require immediate intervention but also allow detection of other, often more subtle injuries that may lead to instability or poor functional outcomes if appropriate treatment is delayed. Awareness and detection of these injuries may be improved by a better-developed and more intuitive understanding of the mechanisms that underlie the most common injury patterns. Ideally, such understanding should prompt appropriate early use of advanced imaging techniques. Traumatic elbow injuries should be described in the radiology report within the context of their clinical significance and their implications for management, information that is often best captured by the injury grading and classification systems used by the orthopedic surgery community. This article reviews the relevant anatomy and functional stability of the elbow and discusses common traumatic elbow injury patterns, including elbow dislocations as well as fractures of the distal humerus, radial head and neck, coronoid process, and olecranon. Less commonly encountered injury constellations that are clinically significant are also described. Injury patterns are explained in the context of the responsible force mechanism by using three-dimensional modeling and animation, with emphasis on the functional impact of associated secondary bone and soft-tissue injuries. The utility of cross-sectional imaging modalities such as computed tomography and magnetic resonance imaging in the acute care setting is discussed, and specific imaging guidelines are provided. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.333125176/-/DC1.

A systematic, multimodality approach to emergency elbow imaging

“…The superficial musculotendinous stabilizers arise from the medial humeral epicondyle and include the common flexor tendon and the pronator teres. The common flexor tendon refers to a shared tendinous origin of the flexor carpi ulnaris, flexor carpi radialis, flexor digitorum superficialis, and palmaris longus muscles [1,6].…”

“…Among emergency department (ED) visits for upper extremity injuries, each year, it has been estimated that 15% involve the elbow and forearm [1]. In a recent epidemiologic study of collegiate baseball injuries, 9-11% were to the elbow, and among those, approximately 70% were associated with throwing [2].…”

Dirseğin Patolojik Değişiklikleri

“…Çıkık olgularının %80- 90'ında radyus ve ulna posteriyora doğru yer değiştirir. Bu durum, sıklıkla dirsek hiperekstansiyondayken oluşan travmayla gelişir [14]. Anteriyor çıkık nadir olup, sıklıkla çocuklarda posteriyor çıkık sonrası eklem ilişkisinin geri gelmesi sonucu gelişmektedir.…”

“…Anteriyor çıkık nadir olup, sıklıkla çocuklarda posteriyor çıkık sonrası eklem ilişkisinin geri gelmesi sonucu gelişmektedir. Diverjan çıkık; proksimal radyus ve ulnanın birbirinden uzaklaşması ve humerusun radyus ile ulna proksimalleri arasına doğru yer değiştirmesidir ve oldukça nadirdir [14,15]. Radyoulnar çıkığın tipik örnekleri olan Essex-Lopresti kırıklı-çı-kığı ile Monteggia ve Galeazzi'de, interossöz membranın santral bant yırtılması radyus ve ulna ayrılmasında kritik role sahip olduğundan MR ile değerlendirilmelidir [1].…”

Tension plate for treatment of olecranon fractures: new surgical technique and case series study

“…1,2 Only 5%-7% of these fractures occur without substantial displacement of fractured fragments, while more than 93% include fragment dislocation that requires active surgical intervention. [3][4][5][6] Given that these are intra-articular fractures, it is very important to achieve precise anatomic fragment reduction and stable osteosynthesis and to start with early mobilization and physical therapy. Nowadays a number of operative methods are used; 2 of the most frequent are tension band wiring and osteosynthesis with a plate and screws.…”