It is convenient, attempt active elbow flexion and extension while the humerus is on a flat surface. It is to be worn for two or three weeks and followed by an x-ray evaluation seven days later. The initial immobilization may be carried out by plaster or sling in functional position. The local anesthesia test is used to search for mechanical occlusion which could determine surgical resolution. However, some authors extend the indication to all fractures which do not block the joint (test through anesthesia) in spite of their having further displacements that evolve toward non-strengthening, and the fragment is to be dried similarly. Indication for non-displaced fractures, displaced with a joint step under 2 mm, a joint surface condition under 30%, and angling under 30 degrees. Aspects to keep in mind for therapeutical decisions are patient-related and include age, bone quality, functional demand, comorbidities, fracture-related extension, location, displacement, and related injuries. Objectives are to achieve an appropriate range of motion with an early rehabilitation start, elbow and forearm stability, and to avoid immediate and long-term complications (arthritis). Type 3 injuries are nonrepairable fractures with internal fixation. Type 2 fractures have a partial head displacement that blocks the pronation and supination, and repairable with internal fixation. Type 1 fractures are nondisplaced or mínimum displaced fractures (below 2 mm). Hotchkiss modifies the types mentioned above with ones by therapeutic criteria. Lately, Morrey has included the classical description of joint fractures, those of the neck, quantifying them to 30% approximately and displacements between 2 mm. Johnston suggests Type 4to be any fracture with elbow luxation. Type 2 is displaced with one fragment fracture. Mason is a widely-used classification system. If there is pain in the wrist and comminuted fractures, it is useful to request x-rays to compare them. Capitulum, coronoid, and olecranon are among the most frequent related fractures.Īssessing the elbow, shoulder, and wrist stability is helpful.Īnteroposterior and lateral x-rays are useful. It is useful to make the radius climbing and descending in the surgery and to identify it with the intensifier climbing at elbow level and with the distal radioulnar joint to diagnose this type of injury. Most complex injuries have been associated with lateral and medial ligaments injuries and interosseous membrane (Essex Lopresti). When there is a doubt as to the size and displacement of the fragment, it is useful to test with a local anesthetic injection to determine if it causes mechanical blockages, which indicates the need for surgical treatment. The medial aspect of the elbow (LCI), the interosseous membrane, and the distal ulnar radius joint should be evaluated, especially in complex cases.
Suspecting possible associated lesions is important. In incomplete or nondisplaced fractures, it is necessary to investigate painful spots and the presence of small petechiae. Moreover, it is involved in longitudinal stability. The radial head stabilizes in valgus when the internal ligament complex is injured, and it does not take part when being harmless (secondary stabilizer). The physiologic elbow range of movement is zero to 150 degrees of flexion and extension, and 85 degrees of pronation, and 75 degrees of supination. They are closely related to the lateral ligament complex, mainly the annular ligament and radial collateral ligament. The head and neck are not collinear with the diaphysis and complete a 15-degree offset angle. It has a 40-degree central cavity, and it is oval-size-like. Cartilage covers the radial head except for the anterolateral third that lacks subchondral bone, and it is easily fractured. A 180-degree arch in the pronation and supination is allowed by the articulation of the proximal end of the radius with the distal humerus (capitulum), and with the ulna in the lesser sigmoid cup (trochoid joint).
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