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Elbow fracture — Clinical Guidelines

Overview

Elbow fractures involve disruptions to the bones forming the elbow joint, often resulting from trauma or repetitive stress, impacting function and causing pain. 10

Diagnosis

Clinical History and Examination: Detailed history including mechanism of injury and physical examination focusing on range of motion, tenderness, and deformity 8.

Imaging Studies: Radiography is essential for initial assessment; advanced imaging like MRI and CT can provide detailed anatomic information 7.

Special Signs: Extension-supination sign may indicate intra-articular fluid placement prior to arthroscopy 9.

Thermography: Useful for distinguishing between tennis elbow and posterior interosseous nerve entrapment 11.

Management

Conservative Treatment: Initial management often includes immobilization, followed by physiotherapy to restore range of motion and strength 2.

Injection Therapy: Corticosteroid injections may provide short-term pain relief but caution is advised due to potential long-term recovery delays 4.

Surgical Intervention: Indicated for displaced fractures, complex intra-articular fractures, or when conservative measures fail 5.

Manipulation Under Anesthesia (MUA): Considered for post-surgical stiffness impacting daily activities 2.

Special Populations

Pediatrics: "Nursemaid's elbow" (radial head subluxation) is common in infants under six months, often due to sudden pulling 10.

Elderly: Increased risk of complex fractures and comorbidities affecting treatment approaches 8.

Key Recommendations

Initial Radiographic Assessment: Essential for diagnosing elbow fractures and guiding further management 7. (Evidence: Strong)

Consider Conservative Management First: Immobilization followed by physiotherapy is often sufficient for non-displaced fractures 2. (Evidence: Moderate)

Use Corticosteroid Injections with Caution: Short-term pain relief is possible but may delay recovery 4. (Evidence: Moderate)

Surgical Consultation for Complex Cases: Recommended for displaced fractures or when conservative treatments fail 5. (Evidence: Moderate)

Physician Training in Elbow Ultrasound: Utilizing simple positions like 90° flexion/neutral for accurate assessment can be beneficial 1. (Evidence: Weak)

References

1 Abogamal A, Ghanem S, Saad H. A single simple position for ultrasound assessment of both common extensor and common flexor origin at the elbow. Advances in rheumatology (London, England) 2019. link 2 Rotman D, Factor S, Schermann H, Kadar A, Atlan F, Pritsch T et al.. Manipulation under anesthesia for the postsurgical stiff elbow: a case series and review of literature. European journal of orthopaedic surgery & traumatology : orthopedie traumatologie 2019. link 3 Laratta J, Caldwell JM, Lombardi J, Levine W, Ahmad C. Evaluation of common elbow pathologies: a focus on physical examination. The Physician and sportsmedicine 2017. link 4 Titchener AG, Booker SJ, Bhamber NS, Tambe AA, Clark DI. Corticosteroid and platelet-rich plasma injection therapy in tennis elbow (lateral epicondylalgia): a survey of current U.K. specialist practice and a call for clinical guidelines. British journal of sports medicine 2015. link 5 Byram IR, Kim HM, Levine WN, Ahmad CS. Elbow arthroscopic surgery update for sports medicine conditions. The American journal of sports medicine 2013. link 6 Keefe DT, Lintner DM. Nerve injuries in the throwing elbow. Clinics in sports medicine 2004. link 7 Fritz RC, Breidahl WH. Radiographic and special studies: recent advances in imaging of the elbow. Clinics in sports medicine 2004. link 8 Cain EL, Dugas JR. History and examination of the thrower's elbow. Clinics in sports medicine 2004. link 9 Cohen B, Constant CR. Extension-supination sign in prearthroscopic elbow distension. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 1992. link90035-a) 10 Newman J. "Nursemaid's elbow" in infants six months and under. The Journal of emergency medicine 1985. link90247-1) 11 Shilo R, Engel J, Farin I, Horochowski H. Thermography as a diagnostic aid in tennis elbow. Handchirurgie 1976. link

Elbow fracture