Surgical Care at the District Hospital
Part 1 2 3 4 5 6 Primary Trauma Care Manual
Traumatology and orthopaedics
Acute Trauma Management
Trauma in perspective
Principles of Primary Trauma Care
Six phases of Primary Trauma Care
Procedures
Orthopaedic Techniques
Traction
Casts and Splints
Application of external fixation
Diagnostic imaging
Physical therapy
Crania burr holes
Orthopaedic Trauma
Upper extremity injuries
The hand
Fractures of the pelvis and hip
Injuries of the lower extremity
Spine injuries
Fractures in children
Amputations
Complications
War related trauma
General Orthopaedics
Congenital and developmental problems
Bone tumours
Infection
Degenerative conditions
Trauma in Perspective
 

> CLAVICLE FRACTURES
> ACROMIAL-CLAVICULAR JOINT SEPARATION
> SHOULDER DISLOCATION
> PROXIMAL HUMERUS FRACTURES
> HUMERAL SHAFT FRACTURES
> SUPRACONDYLAR FRACTURES OF THE HUMERUS
> OLECRANON FRACTURES
> FRACTURES OF THE RADIAL HEAD AND NECK
> ELBOW DISLOCATION
> FOREARM FRACTURES
> DISTAL RADIUS FRACTURES
> CARPAL FRACTURES AND FRACTURE DISLOCATIONS





ELBOW DISLOCATION


Dislocations of the elbow occur with a fall on the outstretched arm. They may be in the posterior or posterior lateral direction (Figure 18.24).

Figure 18.24
Figure 18.24


In children, the medial epicondyle of the humerus is often pulled off as the radius and ulna move posteriorly and laterally. With reduction, this fragment may become lodged in the joint and require surgical removal.

Evaluation

Clinically examine the triangular relationship of the ulna and the two epicondyles to ascertain if it is disturbed. The olecranon is felt protruding in a posterior direction and any elbow motion is painful. Assess and record ulnar nerve function.

Treatment

:: Treat with immediate closed reduction: apply traction to the arm with the elbow in slight flexion and direct pressure on the tip of the olecranon to push it distally and anteriorly.
:: When reduced, the elbow will have a free range of motion. After reduction, confirm the position of the epicondyle by X-ray.
:: Place the arm in a posterior splint at 90 degrees of flexion.
:: Begin a range of motion at the elbow after 10 days, or as soon as the pain and swelling permit, removing the splint for short periods. Discontinue the splint at 4–6 weeks.

> CLAVICLE FRACTURES
> ACROMIAL-CLAVICULAR JOINT SEPARATION
> SHOULDER DISLOCATION
> PROXIMAL HUMERUS FRACTURES
> HUMERAL SHAFT FRACTURES
> SUPRACONDYLAR FRACTURES OF THE HUMERUS
> OLECRANON FRACTURES
> FRACTURES OF THE RADIAL HEAD AND NECK
> ELBOW DISLOCATION
> FOREARM FRACTURES
> DISTAL RADIUS FRACTURES
> CARPAL FRACTURES AND FRACTURE DISLOCATIONS



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  Kep Points  
Injury occurs with a fall on the outstretched arm


Treat with immediate closed reduction



 
In children, the medial epicondyle may become entrapped in the joint and may require surgical removal.