1. Fractures and Dislocations of the Elbow/Forearm
Unit Three Lesson Four

2. BELLWORK “Before & After”
Using a piece of notebook paper, answer the following questions, leaving a line between each answer. Put the paper aside until the end of class. 1. How do you get an arm fracture? 2. How do you get an elbow dislocation? 3. What does an arm fracture look like? 4. What does an elbow dislocation look like?

3. Objective
Differentiate between common injuries and their mechanisms, signs, symptoms and treatments.

4. Terminology
Genetic Hypermobility: a condition in which an individual’s joints can move beyond normal anatomical limits. Intracondylar: the area of a bone that is between two condyles, usually at the distal end of a bone that forms a hinge joint. Supracondylar: the area of a bone that is directly above the condyles, just proximal to the joint.

5. Terminology
Carrying angle: the angle of cubital valgus force created at the humeroulnar joint. This angle allows our arms to swing freely at our sides without hitting our hips. Why do you think females tend to have a bigger carrying angle? Why is it important to check bilaterally when you suspect a fracture?

6. Elbow Fractures

7. Epiphyseal Fracture
Epiphyseal and/or avulsion fractures of the medial epicondyle or the olecranon process are most common in adolescents
Mechanism
FOOSH, direct blow
Signs & Symptoms
Possible deformity, numbness/tingling, pain (severe), TTP at growth plate, loss of ROM, decreased strength, felt or heard a “snap”
Treatment
Splint & sling immediately! Send for x- ray ASAP. Most likely casted for 4-6 weeks
Rehab when appropriate

8. Epiphyseal and/or avulsion fractures of the medial epicondyle or the olecranon process are most common in adolescents
Mechanism
Powerful muscular contraction applied to the medial epicondyle or the olecranon process (avulsion fracture)
Signs & Symptoms
Palpable deformity, numbness/tingling, pain (severe), loss of ROM, decreased strength, most likely heard/felt a “snap”
Treatment
Splint & sling immediately! Send for x- ray ASAP. Most likely casted for 4-6 weeks after surgical repair
Rehab when appropriate
Avulsion Fracture

9. Supracondylar fracture
Supracondylar fractures of the humerus are not common but occasionally occur in contact sports
Mechanism
Powerful valgus or varus force with the elbow locked in a fully extended position (supracondylar fracture)
Extreme hyperextension force (supracondylar fracture)
Signs & Symptoms
Possible deformity, numbness/tingling, pain (severe), loss of ROM, decreased strength, heard or felt a “snap”
Treatment
Splint & sling immediately! Send for x- ray ASAP. Most likely casted for 4-6 weeks
Rehab when appropriate
Supracondylar fracture

10. Intercondylar fracture
Intercondylar fractures of the humerus are rare
Mechanism
Direct impact (intracondylar fracture), FOOSH
Signs & Symptoms
Possible deformity, numbness/tingling, pain (severe), loss of ROM, decreased strength
Treatment
Splint & sling immediately! Send for x- ray ASAP. Most likely casted for 4-6 weeks
Rehab when appropriate

11. Proximal radius and ulna
Other fractures associated with the elbow include the proximal radius and ulna, olecranon process, or the distal humerus

13. Elbow Fracture Signs/ Symptoms
Point tenderness over the medial epicondyle or olecranon process in cases of epiphyseal or avulsion fracture
Obvious deformity (especially present with supracondylar fractures)
Pain 2 inches above the elbow joint on the medial aspect (high suspicion for intercondylar fracture)

14. Forearm Fractures

15. Forearm Fractures Very common in youth sports injury
Often involves both the radius and ulna
When both-bone forearm fractures are located at the distal forearm near the wrist they are termed Colles’ fractures

16. Forearm Fracture Mechanisms
Fall on the outstretched hand (Colles’ Fracture)
Fall on the back of the outstretched hand (Reverse Colles’ Fracture)
Direct Blow

17. Forearm Fracture Signs/Symptoms
Athlete reports feeling a “pop” or “snap”
Obvious Deformity (false joint)
Pain
Swelling
Crepitus

18. Forearm Fracture Treatment
RICE
Splint
Sling
MD Referral

19. Elbow Dislocations

20. Elbow Dislocations Ulna is dislodged from the humerus
Most often ulna moves posteriorly
Somewhat common injury, especially in contact/collision sports

21. Elbow Dislocation Etiology
Violent hyperextension force
Severe blow to the lateral aspect of the elbow while weight is being supported on the hand
Genetic Hypermobility

22. Elbow Dislocation Signs/Symptoms
OBVIOUS DEFORMITY!!!
Severe Pain
Loss of Function

23. Elbow Dislocation Treatment
Treat as a medical emergency!!!
Splint arm/elbow in the position it is found in
Check distal pulses and sensation for vascular and/or nerve impairment

24. “What’s My Injury?”
With a partner, choose an injury from today’s lesson
Write a creative scenario about that injury including the etiology, pathology, and treatment for the injury
Be prepared to share with the class

25. “Before & After” CLOSURE
On your Before and After bellwork sheet, answer the following questions on the line below your “Before” answers. This will assess your new learning for the day! 1. How do you get an arm fracture? 2. How do you get an elbow dislocation? 3. What does an arm fracture look like? 4. What does an elbow dislocation look like?