Elbow fractures are common in motorcycle accidents. Elbow fractures are divided into two types:
• Extra-articular, in which the fracture lines don’t enter the joint
• Intra-articular, in which the joint is involved in the fracture
The elbow is made up of three bones: the ulna, the radius and the humerus. There can be fractures ofany of these bones leading to an elbow fracture. The elbow is responsible for flexion and extension of the forearm. It is also responsible for pronation and supination, which is twisting the hand from palm up to palm down. Most elbow fractures occur as a result of a fall on the outstretched hand. The fracture can easily injure the brachial artery and the median nerve.
A common fracture is called an intercondylar fracture. It involves a vertical fracture of the humerus between the two condyles that enters the joint from above. Adults have them more than children. It is generally caused by a fall onto the flexed elbow. Treatment is complex and usually requires open or closed reduction.
A supracondylar fracture, on the other hand, occurs more in kids than in adults and makes up 60 percent of elbow fractures in the pediatric population. It carries with it the risk of nerve injury to the median, radial, and anterior interosseous nerves. If a nerve is damaged, the motor function generally gets better after 7-12 weeks. The numbness and tingling resolve by 6 months.
The most common complication seen in this type of fracture is called cubitus varus, which is a deformity of the elbow that fortunately doesn’t result in functional loss. It is possible to cut off the brachial artery. If it doesn’t get better after using traction of the arm, emergency surgery to restore circulation is necessary.
In kids with supracondylar fractures, a splint and sling are all that is necessary. Adults with this type of fracture need surgery.
There are also medial and lateral epicondyle fractures, which are considered outside the joint. Medial epicondyle fractures are common in children. These are usually treated conservatively unless the fragment is displaced more than one centimeter or if the joint is unstable. These are treated with surgery.
Lateral epicondyle fractures are not common. Treatment of this fracture includes immobilization with the elbow at 90 degrees and the forearm placed in supination.
There are also medial and lateral condyle fractures. Both types occur in children. In kids, the medial condyle occurs because of a fall on an outstretched hand, while a lateral condyle fracture occurs because of a lateral blow to the elbow or to a varus stress on the elbow.
The radius can be fractured from the elbow to the wrist; however, the two main areas of fracture are the radial head and neck fractures and the distal radial fractures. Radial head fractures can be treated by open and closed methods. Because of the risk of stiffness and a lack of function of the elbow in closed reduction, only the most stable fractures are treated conservatively. The rest of the patients get surgery.
A radial head fracture may be isolated or associated with complex fractures of the elbow. The radial head becomes fractured in almost twenty percent of all cases of elbow trauma and about 33 percent of elbow fractures include some type of injury to the radial head. Radial head fractures happen because of trauma—usually a fall on an outstretched hand. The force of the impact travels through the wrist and up to the head of the radius. The wrist can be damaged at the same time.
If there is bleeding of the elbow along with a radial head fracture, doctors need to be alert to the possibility that the fracture is an open one. There is also the possibility of nerve or blood vessel damage. This needs to be assessed. If the forearm pain is severe and there is swelling, the possibility of compartment syndrome needs to be entertained.
Distal Radial Fracture
A distal radial fracture usually happens at about one inch from the wrist. One of the most common distal radial fractures is called a Colles fracture. It involves a fracture to the distal radius with a tilting of the distal fracture end to the back of the patient’s hand. It can be treated with closed reduction or perhaps surgery in some cases.
There can also be an intra-articular fracture that extends into the wrist joint, extra-articular fracture, which doesn’t include the joint, open fractures which break through the skin, and comminuted fractures, which involve multiple broken pieces. A fracture of the distal ulna can often accompany the radial fracture as they are side by side.
The most common cause of this type of fracture is a fall on an outstretched arm. Osteoporosis is a common risk factor for getting these fractures. In older people, it can take a fall from a standing position to get a distal radial fracture.
Symptoms of a distal radial fracture include pain at the time of the injury, localized tenderness, swelling and bruising of the affected area. The wrist can look deformed. Treatment usually involves a closed reduction with splinting or casting for 6 weeks.
Above is an excellent presentation of how a distal radial fracture may appear.
If you or a loved one has suffered an injury in a motorcycle accident caused by the negligence of another, call me now at (916) 921-6400. If you are outside the Sacramento area, you can call at (800) 404-5400 for free, friendly advice.