Treatment often involves surgery, especially for more complex fractures. However, recent evidence shows that even widely displaced olecranon fractures can be successfully treated conservatively with immobilization in low-demand geriatric patients who do not do heavy lifting or repetitive activities with their upper extremities (Kaiser et al., 2022). nondisplaced to severe displacement and comminution (Riet et al., 2020). Common symptoms related to this injury include lateral elbow pain, swelling, difficulty accomplishing elbow flexion and extension and pain when attempting to do so, and an inability to pronate and supinate the forearm (Githens, 2021). be accompanied by elbow subluxation or dislocation (Fram et al., 2021). For older adults with osteoporotic bones, even a minor fall can cause this fracture (Della Rocca, 2016). Typical symptoms of distal humerus fractures include swelling and bruising, tenderness to palpation, limited elbow flexion and extension range of motion, and a feeling of instability in the elbow joint (as reported by the patient). Clinical examination includes palpation of the distal humerus for areas of tenderness, checking the pulse at the wrist to make sure blood flow has not been interrupted, and assessment of finger and wrist sensation and strength to make sure the ulnar nerve is not involved (Boston Medical Center, n.d.). Conservative treatment is indicated for nondisplaced fractures, while surgical treatment is considered necessary when the fracture is displaced and/or comminuted (Della Rocca, 2016).
Symptoms may include posterior swelling of the elbow, bruising that may travel distally and proximally, tenderness to palpation, possible numbness in the fingers (if neural compression is present), and pain with elbow flexion– extension and forearm pronation–supination (Githens & Della Rocca, 2022). Radial head fracture Radial head fractures are common, with the most frequent mechanism of injury being a fall on an outstretched hand. About 60% of the load transmitted across the elbow joint occurs at the radiocapitellar joint. The load to this joint increases if the elbow is extended and the forearm is pronated. Radial head fractures range from occult Distal humerus fracture Though relatively uncommon, distal humerus fractures involving the capitellum and trochlea are difficult to manage due to their small size, articular nature, and propensity to displace and obstruct elbow motion. As such, these fractures are usually treated operatively with open reduction and internal fixation. Distal humerus fractures are divided into four types. ● Type I : An isolated fracture of the capitellum. ● Type II : An isolated fracture of only the articular rim of the capitellum. ● Type III : A capitellum fracture with any comminution or articular compression. ● Type IV : A capitellum fracture that extends into the trochlea. The mechanism of injury for capitellum fractures is typically a fall onto an outstretched arm, a direct blow to the elbow, or a high-energy event such as a motor vehicle crash. They can
ELBOW ARTHRITIS
process, loose bodies, and chondromalacia of the radius and capitellum are common. This may result in decreased range of motion and pain throughout the range of motion. Athletes with pain in extension should be evaluated for olecranon traction spur or synovial impingement, while athletes with difficulty during pronation–supination might have radioulnar synostosis (Ravilli et al., 2019). Patients with elbow osteoarthritis who are younger than age 40 are likely experiencing this condition because of previous trauma. As such, a thorough review of patient history is important. Arthritis of the radiocapitellar joint is rarely painful, except with rotation. Swelling may be present in the posterolateral elbow. Crepitus with movement is considered a sign of the presence of arthritis. Pain with end range overpressure is indicative of osteophyte formation (Ravilli et al., 2019). Clinical Presentation Upon injury, the child will experience severe pain that quickly subsides. They will then hold their arm on their lap or close to their body and refuse to participate in play or daily activities with that arm. The joint can be easily reduced, typically in an outpatient setting (Card & Lowe, 2023).
Primary elbow osteoarthritis is relatively rare, affecting mainly men who are weightlifters or who have jobs that involve daily heavy lifting. Patients with primary elbow osteoarthritis often complain of impingement pain at full flexion and full extension (Rivalli et al., 2019). Posttraumatic elbow arthritis occurs because of trauma. Intraarticular distal humerus fractures as associated with degenerative joint complications, as is ligamentous instability. Young athletes with serious injuries can experience capitellar osteochondritis dissecans that affect the entire articular cartilage structure. Patients with posttraumatic arthritis have pain throughout the full range of flexion and extension (Rivalli et al., 2019). Athletes involved in throwing, especially those who throw objects (such as shot put or javelin), can experience arthritis related to overuse and repetition. In such situations, formation of osteophytes in the olecranon and coronoid Nursemaid’s elbow Nursemaid’s elbow is a common elbow injury in children between the ages of 6 months and 5 years. It is also called radial head subluxation . It is caused when the child’s outstretched arm is abruptly pulled by the hand or lower arm, resulting in displacement of the annular ligament (Card & Lowe, 2023). The annular ligament encircles the radial head and functions to maintain the proximity of the radial head to the ulna and humerus (Bozurt et al., 2005). With nursemaid’s elbow, the ligament and bone are not necessarily injured; rather, the radial head is malpositioned.
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