Orthopaedic MD

13-Humerus Distal -Comprehensive Classification of Fractures of Long Bones

AONA posting of the AO Classification of Long Bone Fractures

"21-Radius/Ulna Proximal,fracture classification and diagnosis, AO North America -Comprehensive Classification of Fractures of Long Bones"

Fractures of the Capitellum
- uncommon fracture which is difficult to diagnose if fracture fragment is small;
- any effusion within the elbow joint together with displacement of fat pads suggests either a capitellum fracture or nondisplaced fracture of radial head
Wheeless' Textbook of Orthopaedics

Classification and treatment:
- type I: fracture of the tip of the coronoid process;
- type II: fracture or comminution constitutes about half of coronoid;
- treated with early motion if no instability is present;
- type III: fracture or comminution constitutes more than half of coronoid;
- almost always involves dislocation (see below);
- fractures near the coronoid base are associated with increased instability due to loss of the stabilizing function of coronoid itself as well as loss of the insertion of the anterior band of the MCL and anterior joint capsule
Wheeless' Textbook of Orthopaedics

Menu of topics
- Adult Condylar Fractures: (surgical technique)
- capitellar and coronal shear frx
- distal humerus frx:
- lateral condyle frx:
- medial condyle frx:
- distal humeral non union:
- ulnar nerve in condylar fractures:
- Pediatric Elbow Injuries
- distal humeral physeal separation:
- lateral condyle frx, pediatric
- medial epicondyle frx of the humerus
- supracondylar frx of humerus
Wheeless' Textbook of Orthopaedics

Includes introduction, differentials, and findings (including X-rays). Free, but requires registration. Professional eMedicine article

- common fracture in children (20% of pediatric elbow fractures);
- occurs most often between 6-10 yrs of age;
- mechanism: fall on the outstretched arm with forearm in abduction & elbow in extension;
- fractures of the lateral condyle of humerus are unstable & tend to become displaced even when immobilized because of pull of forearm extensors;
- these fractures are also prone to non union since the frx is intra-articular & is bathed in synovial fluid
Wheeless' Textbook of Orthopaedics

Low energy olecranon fractures:
- most commonly occur in elderly patients, and result from indirect trauma;
- fracture results from a sudden pull of both the triceps and brachialis muscles;
- fracture begins at midpoint of trochlear notch and extends distally to enter semilunar notch;
- amount of fracture displacement is influenced by the pull of the triceps muscle as well as any disruption of triceps aponeurosis or periosteum;
High energy fractures:
- olecranon fractures in younger patients are more often high energy injuries, resulting from direct trauma;
- often there is associated comminution or concomitant ulnar shaft fracture;
Wheeless' Textbook of Orthopaedics

- third most common pediatric elbow fracture (5-10%) (behind supracondylar and lateral condylar fractures);
- most common between ages of 9 and 14 years;
- mechanism of injury is valgus strain of the joint, producing traction on the medial epicondyle thru the flexor muscles
Wheeless' Textbook of Orthopaedics

Olecranon fracture treatment
OTA Basic Fracture Course
Gregory J. Schmeling, MD

List of topics associated with Paediatric Elbow Injuries
- Distal Humeral Physeal Separation:
- Elbow Dislocation
- Lateral Condyle Fracture
- Medial Condyle Fracture
- Medial Epicondyle Fracture
- Nursemaid's Elbow
- Olecranon Fracture
- Osteochondritis
- Osteochondrosis of Medial Epicondyle
- Radial Neck Fracture
- Supracondylar Fracture of Humerus
- Throwing Elbow Injuries Wheeless' Textbook of Orthopaedics

Supracondylar Elbow Fractures: Pediatric
Kathryn Cramer MD
OTA Basic Fracture Course

Supracondylar Humeral Fractures Classification
James F. Kellam, MD
OTA Basic Fracture Course