1. As the ELBOW Bends
MI Zucker, MD

2. A dr Z lecture

3. On Common Injuries of the Elbow and Forearm
of ADULTS and KIDS

4. ANATOMY: Adult
AP View

5. ANATOMY: Adult
Lateral View

6. ANATOMY: Kid
AP View

7. ANATOMY: Kid
Lateral View

8. ANATOMY: Kid Special Lines
Anterior Humerus Line
Radius-capitellum Line

9. The Famous FAT PADS Anterior and Posterior
Intracapsular and extrasynovial

10. Anterior FAT Pad It is normal, but only when it’s normal!
Sharp, small, hugs bone

11. Normal Fat Pad

12. The Posterior FAT Pad
It is ALWAYS abnormal!

13. Abnormal FAT Pads
Anterior Fat Pad
Posterior Fat Pad

14. The Injuries

15. RADIUS HEAD Fractures Very common
Can be obvious, but often very subtle or occult
Almost always have abnormal fat pads

16. Radius Head Fractures
Most treated very conservatively: 3 weeks in a sling, physical therapy.

17. Radius Head Fractures A few need surgery The Rule of 3’s If more than:
1/3 of articular surface involved
More than 30 degrees angulation
More than 3mm depression

18. Olecrannon Process Fractures
Unstable due to triceps muscle traction
ORIF

19. Coronoid Process Ulna Fractures
May be isolated
-but-

20. Dislocation
May be a subtle clue to a spontaneously or patient-reduced dislocation, with severe ligament instability

21. Adult Supracondylar Fractures
Not subtle, high energy, very unstable
ORIF

22. The KID Elbow
CRITOE
The appearance of the growth centers

23. The Big 3 of the KID Elbow Supracondylar fracture
Lateral Condyle fracture
Medial Epicondyle avulsion
(In order of prevalence)

24. Supracondylar Fractures
Fraught with complications: Vascular
Nerve
Osseous

25. Lateral Condyle FracturesAP

26. Medial Epicondyle Avulsion Fractures
Little Leaguer’s or Pitcher’s Elbow
Acute
-or-
Subacute (stress)

27. Medial EPICONDYLE Avulsion Fracture
Remember: CRITOE
Internal (medial) epicondyle
-appears BEFORE-
Trochlea

28. Fractures of the RADIUS and ULNA Shafts
Adults and older children:
Unstable. ORIF
In kids, frequently closed reduction and cast is OK

29. MONTEGGIA Fracture Proximal ULNAR Shaft Fracture -and-
RADIAL Head Dislocation
ORIF

30. GALEAZZI Fracture Distal RADIAL Shaft Fracture -and-
Distal ULNAR Dislocation
ORIF

31. Parry Fracture AKA “Nightstick Fracture”
Isolated usually nondisplaced ULNA shaft fracture

32. KID Forearm Fractures Elastic bowing Plastic bowing Greenstick
Torus or buckle

33. Elastic and Plastic Bowing
Microfractures

34. Incomplete or Greenstick Fractures
One margin of cortex remains partially intact

35. Combined Plastic bowing deformity of one bone
Greenstick or complete fracture of the other bone

36. Torus or Buckle Fracture
Obvious
Subtle

37. Torus or Buckle Fracture
The LATERAL view is very helpful in subtle cases
Look for the BUMP

38. INTENTIONAL INJURY CHILD ABUSE
An acute and subacute fracture of the ulna and a dislocation of the radius head

39. INTENTIONAL INJURY
“SELFOGENIC”
Paper clips

40. GOODBYE
Copyright 2004
MI Zucker, MD