Elbow Trauma

Excerpt

Elbow trauma is a common complaint in the acute care setting. In general, these injuries encompass a vast array of patterns, from mild soft tissue injuries and contusions to complex osseoligamentous injury patterns and terrible triad injuries. In the adult patient, most of these acute injuries occur secondary to high-energy mechanisms such as falls from height or motor vehicle accidents (MVAs). Older patients, however, are at risk for elbow injuries and traumatic fractures following low-energy falls. The latter occurs secondary to many factors, including deconditioning, decreased agility and balance, poor vision, decreased muscle mass, and osteopenia or osteoporosis. As such, the approach to treating elbow trauma may vary considerably based on medical history and physical exam.

Anatomy is important for clinicians treating elbow trauma because of the complexity of range of motion (ROM), ligamentous support, and articulations. The elbow joint is one of the most complex joints in the human body, comprised of 3 distinct articulations: ulnohumeral, radiohumeral, and proximal radioulnar joints. The anterior aspect of the proximal ulna (ie, the trochlear notch or semilunar notch) articulates with the trochlea of the distal humerus on the medial side of the elbow joint. The capitellum, a distinct ossification center at the lateral distal humerus, articulates with the radial head. The radial neck and the proximal radial metaphyseal region include the radial tuberosity, the attachment site of the distal biceps tendon. The ulnar collateral ligament (UCL) and lateral collateral ligament (LCL) complex play an important role in stabilizing the joint to valgus and varus stress throughout the arc of motion. Moreover, these ligaments contribute to the physiologic rotational stability of the elbow joint. The transition between the upper arm and the forearm is the region of the antecubital fossa, which contains the radial nerve, brachial artery, and median nerve.