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Elbow Fracture Treatment & Management

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

Emergency Department Care

Emergency physicians need to do a thorough neurovascular examination as well as evaluate for concurrent injuries.

Provide adequate analgesia to achieve patient comfort in the ED.

Proper immobilization for the various types of elbow fractures is indicated.

Assess whether the patient needs orthopedic evaluation in the ED, admission to the hospital for observation, or if discharge and follow up with an orthopedic surgeon is adequate.

Next

Consultations

All elbow fractures should be referred for orthopedic follow-up.

Urgent orthopedic consultation in the ED is required in the following situations:

  • If an open fracture or an open joint is suspected
  • If the injury poses a significant risk of neurovascular injury such as a displaced supracondylar fracture
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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].

  4. Gupta R. Intercondylar fractures of the distal humerus in adults. Injury. 1996 Oct. 27(8):569-72. [Medline].

  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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