Adult Elbow: Fractures

Abstract

The elbow is a complex joint comprising two independent articulations, the ulnotrochlear (allowing flexion and extension) and the radiocapitellar (performs forearm rotation). It is highly constrained by collateral ligaments, which supplement stability of the joint and therefore important in the pathogenesis of elbow instability and dislocations. The bony anatomy of the coronoid is also important in conferring anterior-posterior static stability, creating a hemicircumferential articulation. Stressful activities exert predominantly a valgus stress on the elbow, and the medial collateral ligaments and radial head confer stability in this situation.

The complex anatomy and predominance of intra-articular fracture patterns of the elbow require accurate diagnosis and diligent management to prevent chronic pain and restriction of joint motion. Impaired range of movements can result in difficulty with basic daily activities, for example eating and perineal hygiene. Historically, fusion was a last-resort treatment option and is rarely performed today as no best single fixed elbow position exists. Arthroplasty is gaining interest, but its durability especially in young active patients still remains poor. Surgical fixation with open reduction and internal fixation remains key to restoring articular anatomy, but care of crucial neighboring structures must be maintained. Whether performing surgical or nonsurgical treatment, emphasis on early motion following all injures to prevent long-term stiffness is paramount.