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Elbow Fracture Follow-up

  • Author: Daniel K Nishijima, MD, MAS; Chief Editor: Trevor John Mills, MD, MPH  more...
 
Updated: Jan 22, 2016
 

Further Outpatient Care

Supracondylar fracture

Refer patients with nondisplaced fractures to an orthopedist within 24 hours to evaluate and recheck neurovascular status.

Upon dissipation of edema, apply a long-arm cast that holds the elbow in 90° of flexion for approximately 6 weeks.

Radial head fracture

For uncomplicated fractures, begin range of motion exercises within 3-7 days to reduce the risk of permanent loss of motion from elbow joint contracture.

Intra-articular fractures, which may require radial head excision or fixation, should be seen by an orthopedist within 1 week for definitive management.

Olecranon fracture

Nonoperative fractures (minimally displaced with an intact extensor mechanism) can be treated with a splint and range of motion exercises within a few weeks.

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Further Inpatient Care

Open fractures require extensive irrigation and appropriate prophylactic antibiotics, such as cefazolin and gentamicin.

Displaced supracondylar fractures require surgical intervention and continual monitoring of neurovascular status.

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Inpatient & Outpatient Medications

As with all fractures, address adequate outpatient analgesia, especially during the first few days.

Acetaminophen, with codeine or hydrocodone, may be appropriate treatment.

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Complications

Cubitus varus

The most common complication for supracondylar fractures are cubitus varus or "gunstock deformity", which is a loss of the carrying angle and results in more of a cosmetic disability rather than a functional disability (see the image below).

Cubitus varus. Cubitus varus.

Volkmann ischemia

This is a form of compartment syndrome that can lead to muscle ischemia and permanent muscle contracture, particularly occurring in children. Symptoms suggestive of this complication include pain with passive extension of the fingers, refusal to open the hand, and forearm tenderness.

Median nerve injury

Displaced supracondylar humerus fractures may lead to median nerve dysfunction. Rarely does this result in complete nerve transection, and full return of function is common.

Malunion

Angulated or displaced fractures that remain unreduced lead to functional and cosmetic deformities.

Radial head fracture

Nondisplaced fractures that are immobilized for prolonged periods of time may have permanently decreased range of motion.

Comminuted radial head fractures associated with undiagnosed distal radial-ulnar joint injuries can lead to permanent wrist injuries and loss of pronation/supination motion.

Olecranon fracture

An ulnar nerve injury, although rare, may be associated with a displaced olecranon fracture.

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Prognosis

Supracondylar fracture

Children: Undisplaced fractures and properly managed displaced/angulated fractures result in no long-term functional deficits.

Adults: Usually, range of motion decreases somewhat but without functional deficit.

Radial head fracture

Usually, no functional loss occurs with nonoperative treatment.

Olecranon fracture

This fracture may result in loss of full extension but usually restores strength.

Olecranon fracture can be associated with post-traumatic arthritis of the elbow.

Most operative and nonoperative cases of olecranon fracture have a good outcome with no long-term deficits.

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Patient Education

For patient education resources, see the Breaks, Fractures, and Dislocations Center, as well as Broken Elbow and Elbow Dislocation.

For more information, see Medscape’s Fracture Resource Center.

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Contributor Information and Disclosures
Author

Daniel K Nishijima, MD, MAS Assistant Professor of Emergency Medicine, Associate Research Director, Department of Emergency Medicine, University of California, Davis, School of Medicine

Daniel K Nishijima, MD, MAS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Matthew Goldman, MD Associate Medical Director, Department of Emergency Medicine, Southside Hospital, NS-LIJ

Matthew Goldman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Additional Contributors

Francis Counselman, MD, FACEP Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School

Francis Counselman, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Norfolk Academy of Medicine, Association of Academic Chairs of Emergency Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Tom Scaletta, MD President, Smart-ER (http://smart-er.net); Chair, Department of Emergency Medicine, Edward Hospital; Past-President, American Academy of Emergency Medicine

Tom Scaletta, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

References
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  2. Roust AF, Bredenkamp JH, Uehara DT. Injuries to the elbow and forearm. Tintinalli JE, Kelen GD, Stapczynski JS, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York: McGraw Hill Text; 2003. 1691-1694.

  3. Goldflam K. Evaluation and treatment of the elbow and forearm injuries in the emergency department. Emerg Med Clin North Am. 2015 May. 33 (2):409-21. [Medline].

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  5. Wilkins KE. Fractures and dislocations of the elbow region. Rockwood CA, Wilkins KE, King RE, ed. Fractures in Children. 4th ed. Philadelphia: JB Lippincott; 1996. 653.

  6. Brown IC, Zinar DM. Traumatic and iatrogenic neurological complications after supracondylar humerus fractures in children. J Pediatr Orthop. 1995 Jul-Aug. 15(4):440-3. [Medline].

  7. Harris IE. Supracondylar fractures of the humerus in children. Orthopedics. 1992 Jul. 15(7):811-7. [Medline].

  8. Nicholson DA, Driscoll PA. ABC of emergency radiology. The elbow. BMJ. 1993 Oct 23. 307(6911):1058-62. [Medline].

  9. Skaggs D, Pershad J. Pediatric elbow trauma. Pediatr Emerg Care. 1997 Dec. 13(6):425-34. [Medline].

  10. Shearman C, el-Khoury GY. Pitfalls in the radiologic evaluation of extremity trauma: Part 1. The upper extremity. Am Fam Physician. 1998. 58:1298. [Medline].

  11. Vinson DR, Kann GS, Gaona SD, Panacek EA. Performance of the 4-way range of motion test for radiographic injuries after blunt elbow trauma. Am J Emerg Med. 2015 Oct 24. [Medline].

  12. Rabiner JE, Khine H, Avner JR, Friedman LM, Tsung JW. Accuracy of point-of-care ultrasonography for diagnosis of elbow fractures in children. Ann Emerg Med. 2013 Jan. 61 (1):9-17. [Medline].

  13. Rabiner JE, Khine H, Avner JR, Tsung JW. Ultrasound findings of the elbow posterior fat pad in children with radial head subluxation. Pediatr Emerg Care. 2015 May. 31 (5):327-30. [Medline].

  14. Kuntz DG Jr, Baratz ME. Fractures of the elbow. Orthop Clin North Am. 1999 Jan. 30(1):37-61. [Medline].

  15. Karlsson MK, Hasserius R, Karlsson C, et al. Fractures of the olecranon: a 15- to 25-year followup of 73 patients. Clin Orthop. 2002 Oct. 205-12. [Medline].

  16. Steinberg G, Adkins C, Baran D. Orthopaedics in Primary Care. 2nd ed. Williams & Wilkins; 1992. 62-85.

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Intercondylar fracture.
Supracondylar fracture.
Displaced supracondylar fracture.
Medial epicondyle fracture.
Lateral condyle fracture.
Radial head fracture.
Olecranon fracture.
Anterior and posterior fat pads with radial head fracture.
Cubitus varus.
Table. CRITOE.
Ossification CentersAge of Appearance, y
Capitellum1-2
Radial head4-5
Internal (medial) epicondyle4-5
Trochlea8-10
Olecranon8-9
External (lateral) epicondyle10-11
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