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At least 235 records · Page 13Linked to original sources
PubMed2005

Bilateral radial head fractures in a woman with trivial trauma.

Radial head fractures are common injuries, occurring in about 20% of all acute elbow injuries. Isolated radial head fractures are not common and include about 2% of all fractures around the elbow. Bilateral radial head fractures are rare and usually associated with severe trauma and associated fractures and dislocations. We report a case of bilateral undisplaced radial head fracture in a woman, following a simple fall. Early recognition, proper management, and physical therapy led to complete recovery and full functional movement of the elbow.

Accidental Falls↗
PubMed2000

History and radiographic findings associated with clinically suspected radial head subluxations.

OBJECTIVES: To determine: 1) physician practices regarding the use of radiographs for radial head subluxations (RHS), 2) the prevalence of missed fractures in children with a clinical diagnosis of RHS, 3) the relative risk of a fracture with a nonclassic history for mechanism of injury for RHS, and 4) radiographic findings associated with RHS that are difficult to reduce. METHODS: This study began with a physician survey that addressed the integration of radiographs into the management of RHS. We subsequently conducted a prospective randomized trial with a consecutive sampling of children less than 6 years of age who presented to one of 2 urban pediatric emergency departments and 2 suburban pediatric urgent care centers with a clinical diagnosis of RHS. After informed consent was obtained, reduction was undertaken with a maximum of four attempts (two by hyperpronation and two by supination/flexion), 15 minutes apart. Failure to reduce the RHS resulted in the procurement of a radiograph of the elbow. At the conclusion of the study, all radiographs were evaluated by a radiologist blinded to the diagnosis. Patients receiving radiographs were contacted 2 weeks after discharge for verification of the diagnosis. RESULTS: Eighty-four percent of 224 physicians returned completed surveys. Fifty-six percent reported using radiographs for failed reduction attempts. In the second phase of the study, 136 patients were enrolled prospectively: 127 were reduced successfully and 9 patients failed attempts at reduction. Of the nine patients receiving radiographs: four had fractures (prevalence of 2.9% with 95% confidence interval (CI) = 0.8-7.4), two had no radiographic findings and normal function on follow up, and three had isolated posterior fat pads on radiograph and normal function on follow-up. The relative risk of a fracture in children with a nonclassic history defined as any mechanism other than "pull" was 1.200 (95% CI = 0.441-3.264); the relative risk was 1.886 (95% CI = 0.680-5.231) when defining a nonclassic history as any mechanism other than "pull" or "fall." CONCLUSIONS: 1) Physicians tend to order radiographs for elbow injuries they initially perceive to be radial head subluxations when attempts at reduction fail. 2) In our study, fractures in children who presented with the classic flexed elbow/pronated wrist position were rare. 3) The relative risk of a fracture in children with a nonclassic history for mechanism of injury was not significant. 4) An isolated finding of a posterior fat pad in a child with RHS that is difficult to reduce was not associated with a fracture in our small sample of children with radiographic findings.

Child, Preschool↗
PubMed1999

Emergency department evaluation and treatment of elbow and forearm injuries.

This article reviews the anatomy of the elbow and discusses several different types of elbow fractures and dislocations. A review of forearm anatomy and common injuries, trauma, and fractures follows. Methods for treatment and management for both elbow and forearm injuries are discussed.

Emergency Service, Hospital↗
PubMed2006

Supracondylar humeral fractures in children: ten years' experience in a teaching hospital.

Although supracondylar fracture is a very common elbow injury in childhood, there is no consensus on the timing of surgery, approach for open reduction and positioning of fixation wires. We report our ten-year experience between 1993 and 2003 in 291 children. Most fractures (285; 98%) were extension injuries, mainly Gartland types II (73; 25%) and III (163; 56%). Six (2%) were open fractures and a neurovascular deficit was seen in 12 (4%) patients. Of the 236 children (81%) who required an operation, 181 (77%) were taken to theatre on the day of admission. Most (177; 75%) of the operations were performed by specialist registrars. Fixation was by crossed Kirschner wires in 158 of 186 (85%) patients and open reduction was necessary in 52 (22%). A post-operative neurological deficit was seen in nine patients (4%) and three (1%) required exploration of the ulnar nerve. Only 22 (4%) patients had a long-term deformity, nine (3%) from malreduction and three (1%) because of growth arrest, but corrective surgery for functional limitation was required in only three (1%) patients.

Accidental Falls↗
PubMed1982

[Contrast arthrography in the diagnosis of soft tissue injuries round the elbow joint (author's transl)].

Based on the experience of 115 examinations, the authors first describes the normal radiological appearances on arthrography of the elbow joint. Subsequently, the radiological criteria are discussed which permit a diagnosis of intra- and para-articular soft tissue lesions due to closed trauma of the elbow joint. Arthrography with positive (water-soluble) contrast media enables one to diagnose rupture of the joint capsule and ligaments, and to diagnose with certainty subluxations of the various parts of the joint. Is is also possible to demonstrate haematomas between the muscles, which may lead to a reduction in joint function. Negative contrast medium (carbon dioxide, oxygen) permits the diagnosis of rupture of the insertion of the biceps.

Adolescent↗
PubMed2001

Imaging overuse injury of the elbow in professional team handball players: a bilateral comparison using plain films, stress radiography, ultrasound, and magnetic resonance imaging.

The purpose of this study was to compare the manifestations of elbow stress due to repetitive valgus forces between the dominant and the non-dominant elbow in 40 uninjured elite team handball players using plain films, stress radiographs, ultrasound, and MRI examination. On comparative plain films generalized bony hypertrophy manifested by increased humeral diameter, and cortical hypertrophy of the humeral shaft of the dominant extremity was observed in all players. A significantly greater difference in medial joint space opening between stressed and unstressed elbows was measured in the dominant elbow compared with the non-dominant elbow (0.41 +/- 0.59 mm). The ultrasonographic findings showed statistically significant bilateral differences in the thickness of the flexor-pronator tendon (0.90 +/- 0.56 mm), extensor tendon (0.96 +/- 0.50 mm), triceps tendon (0.69 +/- 0.27 mm), and medial collateral ligament (0.47 +/- 0.24 mm): the values were systematically higher on the dominant side. US examination showed intra-articular effusions in 67% and small loose bodies in 33.3% of the players, exclusively in dominant elbows. MRI showed joint effusion in the same subjects as US, but loose bodies were only detected in half of the cases found by ultrasound. This study demonstrates that repetitive stress on the dominant extremities of handball players is responsible for physiologic and pathologic changes in the dominant elbow.

Adolescent↗
PubMed2001

Brachial artery injury in closed posterior elbow dislocation case report.

The authors describe a case with a closed posterior elbow dislocation associated with a distal radial fracture and complete transsection of the brachial artery. The patient had a pulseless distal upper extremity and immediate gross swelling of the elbow and forearm. As closed reduction was not possible, open reduction had to be performed through an anteromedial approach to the elbow. End-to-end suture of the brachial artery was successful. After fasciotomy and internal fixation of the distal radial fracture, the elbow was stabilized with an external fixator spanning the elbow joint. After two years, despite good function of the elbow, restoration of the hand function is not optimal owing to persistent motor deficit of the ulnar nerve.

Accidental Falls↗
PubMed2002

Hyperextension trauma to the elbow: radiological and ultrasonographic evaluation in handball goalkeepers.

OBJECTIVE: To detect elbow lesions produced by hyperextension in 30 elite handball goalkeepers. METHODS: Conventional radiographs, stress radiographs, and ultrasound examination of both elbows were used. As a control group, 30 male volunteers from the general population within the same age group with no history of elbow injury were used. RESULTS: Radiographic findings in the goalkeepers were osteophyte formation in 67%, loose bodies in 5.5%, and periarticular calcification in 5.5%. Significantly greater differences in medial joint space opening between stressed and unstressed elbows were measured in both elbows than in the control group. Ultrasonographic findings showed thickening of the medial collateral ligament in 50%, thickening of the tricipital tendon in 11%, and signs of ulnar neuritis in 22%. An intra-articular effusion was found in 66% and small loose bodies in 33%. No significant differences were found between the dominant and non-dominant elbows at radiological and ultrasound examination. The findings in the control group were normal. CONCLUSIONS: The findings support the theory that repetitive hyperextension trauma to the elbow in handball goalkeepers results in pathological changes.

Adolescent↗
PubMed1991

Chronic stress injuries of the elbow in young gymnasts.

The radiological changes of chronic stress injuries of the elbow in 19 adolescent elite gymnasts are reported. The principal abnormalities were avascular necrosis of the capitellar epiphysis (Panner's disease) (one patient), post-traumatic subarticular necrosis (osteochondritis dissecans) of the capitellum (six patients) and the medial articular eminence of the distal humerus (one patient). Flattening and anterior depression of the radial head epiphysis with an underlying metaphyseal notch associated with an epiphyseal cleft (three patients), which, in one patient who continued training, developed into a chronic Salter Type IV stress fracture. A further patient, post-epiphyseal fusion, showed osteochondritis dissecans of the anterior aspect of the radial head. Seven patients exhibited a spectrum of olecranon changes from fragmentation of the epiphysis to chronic Salter Type I stress fractures of the growth plate. A follow-up survey found that, of those who responded to a questionnaire, nearly all the patients with articular surface damage failed to continue with competitive gymnastics whereas those with olecranon abnormalities were able to continue gymnastics at the same level. The mechanism of injury and the pathological changes are discussed.

Adolescent↗