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Elbow Fracture Medication

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

Medication Summary

Drugs used to treat fractures are generally NSAIDs, analgesics, and anxiolytics. In addition, administer proper antibiotics and tetanus prophylaxis for open fractures.

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Nonsteroidal anti-inflammatory agents (NSAIDs)

Class Summary

These drugs are used commonly for relief of mild to moderately severe pain. Effects of NSAIDs in treatment of pain tend to be patient specific, yet ibuprofen is usually DOC for initial therapy. Other options include flurbiprofen, ketoprofen, and naproxen.

Ibuprofen (Ibuprin, Advil, Motrin)

 

Usually DOC for treatment of mild to moderately severe pain, if no contraindications. Inhibits inflammatory reactions and pain, probably by decreasing activity of enzyme cyclooxygenase, which inhibits prostaglandin synthesis.

Naproxen (Anaprox, Naprelan, Naprosyn)

 

Used for relief of mild to moderately severe pain. Inhibits inflammatory reactions and pain by decreasing activity of enzyme cyclooxygenase, which decreases prostaglandin synthesis.

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Analgesics

Class Summary

Pain control is essential to quality patient care. It ensures patient comfort, promotes pulmonary toilet, and aids physical therapy regimens. Many analgesics have sedating properties that benefit patients with fractures.

Hydrocodone bitartrate and acetaminophen (Vicodin ES)

 

Drug combination indicated for relief of moderately severe to severe pain.

Oxycodone and acetaminophen (Percocet)

 

Drug combination indicated for relief of moderately severe to severe pain. DOC for aspirin-hypersensitive patients.

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Anxiolytics

Class Summary

Patients with painful injuries usually experience significant anxiety. Anxiolytics allow a smaller analgesic dose to achieve the same effect.

Lorazepam (Ativan)

 

Sedative hypnotic in benzodiazepine class that has a short onset of effect and relatively long half-life. By increasing action of GABA, a major inhibitory neurotransmitter, may depress all levels of CNS, including limbic and reticular formation.

Excellent for sedating patient for longer than 24-h period.

Monitor patient's BP after administering dose and adjust as necessary.

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Antibiotics

Class Summary

These agents are given as prophylaxis to patients with open fractures.

Cefazolin (Ancef)

 

Used along with gentamicin for prophylaxis in patients with open fractures. First-generation semisynthetic cephalosporin that by binding to 1 or more penicillin-binding proteins arrests bacterial cell wall synthesis and inhibits bacterial replication. Poor capacity to cross blood-brain barrier. Primarily active against skin flora, including S aureus. Typically used alone for skin and skin-structure coverage. IV and IM dosing regimens are similar.

Gentamicin (Gentacidin, Garamycin)

 

Aminoglycoside antibiotic used for gram-negative bacterial coverage. Commonly used in combination with both an agent against gram-positive organisms and one that covers anaerobes.

Dosing regimens are numerous and adjusted based on renal function (CrCl) and changes in volume of distribution. Dose may be given IV/IM.

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Toxoid

Class Summary

This agent is used for tetanus immunization. Booster injection in previously immunized individuals is recommended to prevent this potentially lethal syndrome.

Tetanus toxoid adsorbed or fluid

 

Induces active immunity against tetanus in selected patients. Immunizing DOC for most adults and children >7 y are tetanus and diphtheria toxoids. Necessary to administer booster doses to maintain tetanus immunity throughout life. Pregnant patients should receive only tetanus toxoid, not a diphtheria antigen-containing product.

In children and adults, may administer into deltoid or midlateral thigh muscles. In infants, preferred site of administration is midthigh, lateral.

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Immunoglobulins

Class Summary

Patients who may not have been immunized against Clostridium tetani products should receive tetanus immune globulin.

Tetanus immune globulin (TIG)

 

For passive immunization of any person with a wound that may be contaminated with tetanus spores.

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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.

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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.

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  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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