CLASSIFICATION : ELBOW FRACTURES

Fractures of elbow have special importance as elbow is prone for stiffness. Elbow fractures have to be treated meticulously and post operative , elbow should be mobilised properly. Elbow injuries in children can cause angular and rotational deformities. All said and done ,an functional arc of elbow range should always be in back of mind in treatment of elbow fractures.

Supra condylar fracture
Supra condylar fracture is perhaps the commonest fracture in children. It occurs in age group of 5 to 8 years. It occurs on fall on outstretched hand with pronated forearm.

Gartland’s classification
1. Undisplaced fracture
2. Displaced fracture with intact posterior cortex
3. Displaced fracture with no cortical contact
a) Posteromedial
b) Posterolateral


Fracture of lateral condylar Physis
It’s most common physeal injury in elbow occurring around 6 years of age. Forceful adduction of extended elbow of supinated forearm causes this injury.

Milch classification
1.Fracture line transverses into capitellotrochlear groove (Salter Harris type 4)
2.Fracture line traverses into trochlea causing posterolateral instability ( Salter Harris type 2)

Depending on degree of displacement, it is further classified as
1. Undisplaced : Medial articular cartilage intact
2. Moderately displaced
3. Completely rotated
a. Posterolateral subluxation of proximal radius and ulna
b. Cubitus valgus.
c. Lateral translocation of radius and ulna.


Radial head and neck fractures
Radial neck fractures occurs more commonly between ages of 4-14 years. Radial head fractures in adults. It occurs due to fall on outstretched hand with elbow.

The displacement can be
a) Angulation
b) Rotation
c) Translocation
d) Displacement

Wilkins classification
A. Salter Harris type 1,2 injuries of proximal radial physis.
B. Salter Harris type 4 physeal injury
C. Fracture involving metaphysis
D. Fracture when dislocated elbow being reduced
E. Fracture when Elbow being dislocated


Fracture of Inter condylar fracture of humerus
Fracture of intercondylar region of humerus occur in adulthood.These occur due to impaction of olecranon in intercondylar notch.

Classification
1. Undisplaced
2. Displaced
3. Displaced and rotated
4. Communited ( bag of bones)


Dislocations of elbow
Elbow dislocation is more common in adolescent age group. Posterior dislocation is more common with peak in second decade.

Classification
1. Proximal radioulnar joint intact.
A. Posterior :a) Posterolateral (common) b) Posteromedial
B. Anterior
C. Medial
D. Lateral

2. Proximal radioulnar joint disrupted.
A. Divergent 1) Anteroposterior 2) Mediolateral (Transverse)
B. Radio ulnar translocation