Acta Chir Orthop Traumatol Cech. 2012; 79(3):203-212 | DOI: 10.55095/achot2012/030
Current Concepts Review - Fractures in the Region of the ElbowCurrent concepts review
- 1 Department for Trauma Surgery, University of Aachen, Germany
- 2 Hand and Upper Extremity Service , Department of Orthopaedic Surgery, Massachussetts General Hospital, Boston, USA
Elbow injuries continue to rise with increased athletic activity and life expectancy.
Knowledge of anatomy and biomechanics of this sophisticated joint, various injury patterns, and the implication of injury to the static and dynamic stabilizers will result in improvement in specific diagnosis, and therapy. The surgical treatment of trauma to the adult elbow has evolved rapidly in recent years and many useful concepts and techniques have been established.
This paper reviews the published scientific data and current opinion available to guide patient care.
Published: June 1, 2012 Show citation
References
- ANDERSON, M. L., LARSON, A. N., MERTEN, S. M., STEINMANN, S. P.: Congruent elbow plate fixation of olecranon fractures. J. Orthop. Trauma, 21: 386-393, 2007.
Go to original source...
Go to PubMed...
- BAILEY, C. S., MACDERMID, J., PATTERSON, S. D., KING, G. J.: Outcome of plate fixation of olecranon fractures. J. Orthop. Trauma, 15: 542-548, 2001.
Go to original source...
Go to PubMed...
- BEINGESSNER, D. M., DUNNING, C. E., GORDON, K. D., JOHNSON, J. A., KING, G. J.: The effect of radial head excision and arthroplasty on elbow kinematics and stability. J. Bone Jt Surg., 86-A: 1730-1739, 2004.
Go to original source...
Go to PubMed...
- BUIJZE, G., KLOEN, P.: Clinical evaluation of locking compression plate fixation for comminuted olecranon fractures. J. Bone Jt Surg., 91-A: 2416-2420, 2009.
Go to original source...
Go to PubMed...
- CALFEE, R. P., WILSON, J. M., WONG, A. H.: Variations in the anatomic relations of the posterior interosseous nerve associated with proximal forearm trauma. J. Bone Jt Surg., 93-A: 81-90, 2011.
Go to original source...
Go to PubMed...
- CHALIDIS, B. E., SACHINIS, N. C., SAMOLADAS, E. P., DIMITRIOU, C. G., POURNARAS, J. D.: Is tension band wiring technique the "gold standard" for the treatment of olecranon fractures? A long term functional outcome study. J. Orthop. Surg. Res., 3: 9, 2008.
Go to original source...
Go to PubMed...
- CHIN, K. R., RING, D., JUPITER, J. B.: Double tension-band fixation of the olecranon. Tech. Should. Elb. Surg., 1: 61-66, 2000.
- DOORNBERG, J., LINDENHOVIUS, A., KLOEN, P., VAN DIJK, C. N., ZURAKOWSKI, D., RING, D.: Two and three-dimensional computed tomography for the classification and management of distal humeral fractures. Evaluation of reliability and diagnostic accuracy. J. Bone Jt Surg., 88-A: 1795-1801, 2006.
Go to original source...
Go to PubMed...
- DOORNBERG, J. N., PARISIEN, R., VAN DUIJN, P. J., RING, D.: Radial head arthroplasty with a modular metal spacer to treat acute traumatic elbow instability. J. Bone Jt Surg., 89-A: 1075-1080, 2007.
Go to original source...
Go to PubMed...
- DOTZIS, A., COCHU, G., MABIT, C., CHARISSOUX, J. L., ARNAUD, J. P.: Comminuted fractures of the radial head treated by the Judet floating radial head prosthesis. J. Bone Jt Surg., 88-B: 760-764, 2006.
Go to original source...
Go to PubMed...
- EDWARDS, S. G., ARGINTAR, E., LAMB, J.: Management of comminuted proximal ulna fracture-dislocations using a multiplanar locking intramedullary nail. Tech. Hand Up. Extrem. Surg., 15: 106-114, 2011.
Go to original source...
Go to PubMed...
- GALLAY, S. H., McKEE, M. D.: Operative treatment of nonunions about the elbow. Clin. Orthop. Relat. Res., 87-101, 2000.
Go to original source...
Go to PubMed...
- GELINAS, J. J., FABER, K. J., PATTERSON, S. D., KING, G. J.: The effectiveness of turnbuckle splinting for elbow contractures. J. Bone Jt Surg., 82-B: 74-78, 2000.
Go to original source...
- GIVISSIS, P. K., SYMEONIDIS, P. D., DITSIOS, K. T., DIONELLIS, P. S., CHRISTODOULOU, A. G.: Late results of absorbable pin fixation in the treatment of radial head fractures. Clin. Orthop. Relat. Res., 466: 1217-1224, 2008.
Go to original source...
Go to PubMed...
- GOFTON, W. T., MACDERMID, J. C., PATTERSON, S. D., FABER, K. J., KING, G. J.: Functional outcome of AO type C distal humeral fractures. J. Hand Surg., 28-A: 294-308, 2003.
Go to original source...
Go to PubMed...
- GREINER, S., HAAS, N. P., BAIL, H. J.: Outcome after open reduction and angular stable internal fixation for supra-intercondylar fractures of the distal humerus: preliminary results with the LCP distal humerus system. Arch. Orthop. Trauma Surg., 128: 723-729, 2008.
Go to original source...
Go to PubMed...
- GREWAL, R., MacDERMID, J. C., FABER, K. J., DROSDOWECH, D. S., KING, G. J.: Comminuted radial head fractures treated with a modular metallic radial head arthroplasty. Study of outcomes. J. Bone Jt Surg., 88-A: 2192-2200, 2006.
Go to original source...
- HAK, D. J., GOLLADAY, G. J.: Olecranon fractures: treatment options. J. Am. Acad. Orthop. Surg., 8: 266-275, 2000.
Go to original source...
Go to PubMed...
- HAMID, N., ASHRAF, N., BOSSE, M. J., CONNOR, P. M., KELLAM, J. F., SIMS, S. H., STULL, D. E., JERAY, K. J., HYMES, R. A., LOWE, T. J.: Radiation therapy for heterotopic ossification prophylaxis acutely after elbow trauma: a prospective randomized study. J. Bone Jt Surg., 92-A: 2032-2038, 2010.
Go to original source...
Go to PubMed...
- HARRINGTON, I. J., SEKYI-OTU, A., BARRINGTON, T. W., EVANS, D. C., TULI, V.: The functional outcome with metallic radial head implants in the treatment of unstable elbow fractures: a long-term review. J. Trauma, 50: 46-52, 2001.
Go to original source...
Go to PubMed...
- HELFET, D. L., KLOEN, P., ANAND, N., ROSEN, H. S.: Open reduction and internal fixation of delayed unions and nonunions of fractures of the distal part of the humerus. J. Bone Jt Surg., 85-A: 33-40, 2003.
Go to original source...
Go to PubMed...
- HELFET, D. L., KLOEN, P., ANAND, N., ROSEN, H. S.: ORIF of delayed unions and nonunions of distal humeral fractures. Surgical technique. J. Bone Jt Surg., 86-A 18-29, 2004.
Go to original source...
- HERBERTSSON, P., JOSEFSSON, P. O., HASSERIUS, R., BESJAKOV, J., NYQVIST, F., KARLSSON, M. K.: Fractures of the radial head and neck treated with radial head excision. J. Bone Jt Surg., 86-A: 1925-1930, 2004.
Go to original source...
Go to PubMed...
- HEYD, R., STRASSMANN, G., SCHOPOHL, B., ZAMBOGLOU, N.: Radiation therapy for the prevention of heterotopic ossification at the elbow. J. Bone Jt Surg., 83-B: 332-334, 2001.
Go to original source...
- IFTIMIE, P. P., CALMET GARCIA, J., De LOYOLA GARCIA FORCADA, I., GONZALEZ PEDROUZO, J. E., GINE GOMA, J.: Resection arthroplasty for radial head fractures: Long-term follow-up. J. Shoulder Elbow Surg., 20: 45-50, 2011.
Go to original source...
Go to PubMed...
- IKEDA, M., SUGIYAMA, K., KANG, C., TAKAGAKI, T., OKA, Y.: Comminuted fractures of the radial head. Comparison of resection and internal fixation. J. Bone Jt Surg., 87-A: 76-84, 2005.
Go to original source...
Go to PubMed...
- IKEDA, M., YAMASHINA, Y., KAMIMOTO, M., OKA, Y.: Open reduction and internal fixation of comminuted fractures of the radial head using low-profile mini-plates. J. Bone Jt Surg., 85-B: 1040-1044, 2003.
Go to original source...
Go to PubMed...
- JUPITER, J. B.: The management of nonunion and malunion of the distal humerus -a 30-year experience. J. Orthop. Trauma, 22: 742-750, 2008.
Go to original source...
Go to PubMed...
- KAISER, T., BRUNNER, A., HOHENDORFF, B., ULMAR, B., BABST, R.: Treatment of supra- and intra-articular fractures of the distal humerus with the LCP Distal Humerus Plate: a 2-year follow-up. J. Shoulder Elbow Surg., 20: 206-212, 2011.
Go to original source...
Go to PubMed...
- KARLSSON, M. K., HASSERIUS, R., KARLSSON, C., BESJAKOV, J., JOSEFSSON, P. O.: Fractures of the olecranon: a 15-to 25-year followup of 73 patients. Clin. Orthop. Relat. Res., 205-212, 2002.
Go to original source...
- KORNER, J., DIEDERICHS, G., ARZDORF, M., LILL, H., JOSTEN, C., SCHNEIDER, E., LINKE, B.: A biomechanical evaluation of methods of distal humerus fracture fixation using locking compression plates versus conventional reconstruction plates. J. Orthop. Trauma, 18: 286-293, 2004.
Go to original source...
Go to PubMed...
- KORNER, J., LILL, H., MULLER, L. P., HESSMANN, M., KOPF, K., GOLDHAHN, J., GONSCHOREK, O., JOSTEN, C., ROMMENS, P. M.: Distal humerus fractures in elderly patients: results after open reduction and internal fixation. Osteoporos. Int., 16 Suppl 2: S73-79, 2005.
Go to original source...
Go to PubMed...
- KORNER, J., LILL, H., MULLER, L. P., ROMMENS, P. M., SCHNEIDER, E., LINKE, B.: The LCP-concept in the operative treatment of distal humerus fractures-biological, biomechanical and surgical aspects. Injury, 34 Suppl 2: B20-30, 2003.
Go to original source...
Go to PubMed...
- KUNDEL, K., BRAUN, W., WIEBERNEIT, J., RUTER, A.: Intraarticular distal humerus fractures. Factors affecting functional outcome. Clin. Orthop. Relat. Res., 200-208, 1996.
Go to original source...
- LAMAS, C., CASTELLANOS, J., PROUBASTA, I., DOMINGUEZ, E.: Comminuted radial head fractures treated with pyrocarbon prosthetic replacement. Hand (N Y). 6: 27-33, 2011.
Go to original source...
Go to PubMed...
- LAWTON, J. N., CAMERON-DONALDSON, M., BLAZAR, P. E., MOORE, J. R.: Anatomic considerations regarding the posterior interosseous nerve at the elbow. J. Shoulder Elbow Surg., 16: 502-507, 2007.
Go to original source...
Go to PubMed...
- LINDENHOVIUS, A. L., LINZEL, D. S., DOORNBERG, J. N., RING, D. C., JUPITER, J. B.: Comparison of elbow contracture release in elbows with and without heterotopic ossification restricting motion. J. Shoulder Elbow Surg., 16: 621-625, 2007.
Go to original source...
Go to PubMed...
- MACKO, D., SZABO, R. M.: Complications of tension-band wiring of olecranon fractures. J. Bone Jt Surg., 67-A: 1396-1401, 1985.
Go to original source...
- MAGHEN, Y., LEO, A. J., HSU, J. W., HAUSMAN, M. R.: Is a silastic radial head still a reasonable option? Clin. Orthop. Relat. Res., 469: 1061-1070, 2011.
Go to original source...
Go to PubMed...
- MASON, M. L.: Some observations on fractures of the head of the radius with a review of one hundred cases. Br. J. Surg., 42: 123-132, 1954.
Go to original source...
Go to PubMed...
- McKEE, M., JUPITER, J. B.: Fractures of the distal humerus. In: Browner, B. D., Jupiter, J.B., Levine, A.M., et al., editor. Skeletal trauma: Basic science, management, and reconstruction. 3rd ed. Philadelphia, WB Saunders 2003, p. 1436-1480.
- McKEE, M. D., JUPITER, J. B., BOSSE, G., GOODMAN, L.: Outcome of ulnar neurolysis during post-traumatic reconstruction of the elbow. J. Bone Jt Surg., 80-B: 100-105, 1998.
Go to original source...
- McKEE, M. D., KIM, J., KEBAISH, K., STEPHEN, D. J., KREDER, H. J., SCHEMITSCH, E. H.: Functional outcome after open supracondylar fractures of the humerus. The effect of the surgical approach. J. Bone Jt Surg., 82-B: 646-651, 2000.
Go to original source...
- McKEE, M. D., VEILLETTE, C. J., HALL, J. A., SCHEMITSCH, E. H., WILD, L. M., McCORMACK, R., PEREY, B., GOETZ, T., ZOMAR, M., MOON, K., MANDEL, S., PETIT, S., GUY, P., LEUNG, I.: A multicenter, prospective, randomized, controlled trial of open reduction-internal fixation versus total elbow arthroplasty for displaced intra-articular distal humeral fractures in elderly patients. J. Shoulder Elbow Surg., 18: 3-12, 2009.
Go to original source...
Go to PubMed...
- MORITOMO, H., TADA, K., YOSHIDA, T.: Early, wide excision of heterotopic ossification in the medial elbow. J. Shoulder Elbow Surg., 10: 164-168, 2001.
Go to original source...
Go to PubMed...
- MORO, J. K., KING, G. J.: Total elbow arthroplasty in the treatment of posttraumatic conditions of the elbow. Clin. Orthop. Relat. Res., 102-114, 2000.
Go to original source...
Go to PubMed...
- MORREY, B. F.: Current concepts in the treatment of fractures of the radial head, the olecranon, and the coronoid. Instr. Course Lect., 44: 175-185, 1995.
Go to original source...
- MORREY, B. F., AN, K. N.: Stability of the elbow: osseous constraints. J. Shoulder Elbow Surg., 14: 174S-178S, 2005.
Go to original source...
Go to PubMed...
- MULLER, M. E., NAZARIAN, S., KOCH, P., SCHATZKER, J.: The comprehensive classification of fractures of long bones. Heidelberg, Springer-Verlag 1990.
Go to original source...
- NALBANTOGLU, U., KOCAOGLU, B., GERELI, A., AKTAS, S., GUVEN, O.: Open reduction and internal fixation of Mason type III radial head fractures with and without an associated elbow dislocation. J. Hand Surg., 32-A: 1560-1568, 2007.
Go to original source...
Go to PubMed...
- NOLLA, J., RING, D., LOZANO-CALDERON, S., JUPITER, J. B.: Interposition arthroplasty of the elbow with hinged external fixation for post-traumatic arthritis. J. Shoulder Elbow Surg., 17: 459-464, 2008.
Go to original source...
Go to PubMed...
- NOWAK, T. E., BURKHART, K. J., MUELLER, L. P., MATTYASOVSZKY, S. G., ANDRES, T., STERNSTEIN, W., ROMMENS, P. M.: New intramedullary locking nail for olecranon fracture fixation-an in vitro biomechanical comparison with tension band wiring. J. Trauma, 69: E56-61, 2010.
Go to original source...
Go to PubMed...
- O'DRISCOLL, S. W.: Optimizing stability in distal humeral fracture fixation. J. Shoulder Elbow Surg., 14: 186S-194S, 2005.
Go to original source...
Go to PubMed...
- O'DRISCOLL, S. W.: The triceps-reflecting anconeus pedicle (TRAP) approach for distal humeral fractures and nonunions. Orthop. Clin. North Am., 31: 91-101, 2000.
Go to original source...
Go to PubMed...
- PIKE, J. M., ATHWAL, G. S., FABER, K. J., KING, G. J.: Radial head fractures-an update. J. Hand Surg., 34-A: 557-565, 2009.
Go to original source...
Go to PubMed...
- RING, D., ADEY, L., ZURAKOWSKI, D., JUPITER, J. B.: Elbow capsulectomy for posttraumatic elbow stiffness. J. Hand Surg., 31-A: 1264-1271, 2006.
Go to original source...
Go to PubMed...
- RING, D., GULOTTA, L., CHIN, K., JUPITER, J. B.: Olecranon osteotomy for exposure of fractures and nonunions of the distal humerus. J. Orthop. Trauma, 18: 446-449, 2004.
Go to original source...
Go to PubMed...
- RING, D., JUPITER, J. B.: Operative release of complete ankylosis of the elbow due to heterotopic bone in patients without severe injury of the central nervous system. J. Bone Jt Surg., 85-A: 849-857, 2003.
Go to original source...
Go to PubMed...
- RING, D., JUPITER, J. B., GULOTTA, L.: Articular fractures of the distal part of the humerus. J. Bone Jt Surg., 85-A: 232-238, 2003.
Go to original source...
Go to PubMed...
- RING, D., JUPITER, J. B., GULOTTA, L.: Atrophic nonunions of the proximal ulna. Clin. Orthop. Relat. Res., 268-274, 2003.
Go to original source...
Go to PubMed...
- RING, D., QUINTERO, J., JUPITER, J. B.: Open reduction and internal fixation of fractures of the radial head. J. Bone Jt Surg.. 84-A: 1811-1815, 2002.
Go to original source...
Go to PubMed...
- ROBINSON, C. M., HILL, R. M., JACOBS, N., DALL, G., COURT-BROWN, C. M.: Adult distal humeral metaphyseal fractures: epidemiology and results of treatment. J. Orthop. Trauma, 17: 38-47, 2003.
Go to original source...
Go to PubMed...
- ROMMENS, P. M., KUCHLE, R., SCHNEIDER, R. U., REUTER, M.: Olecranon fractures in adults: factors influencing outcome. Injury, 35: 1149-1157, 2004.
Go to original source...
Go to PubMed...
- ROSENBLATT, Y., ATHWAL, G. S., FABER, K. J.: Current recommendations for the treatment of radial head fractures. Orthop Clin North Am. 39: 173-185, vi, 2008.
Go to original source...
Go to PubMed...
- RUAN, H. J., LIU, J. J., FAN, C. Y., JIANG, J., ZENG, B. F.: Incidence, management, and prognosis of early ulnar nerve dysfunction in type C fractures of distal humerus. J. Trauma, 67: 1397-1401, 2009.
Go to original source...
Go to PubMed...
- RUBBERDT, A., SURKE, C., FUCHS, T., FRERICHMANN, U., MATUSZEWSKI, L., VIETH, V., RASCHKE, M. J.: Preformed plate-fixation system for type AO 13C3 distal humerus fractures: clinical experiences and treatment results taking access into account. Unfallchirurg, 111: 308-322, 2008.
Go to original source...
Go to PubMed...
- SANCHEZ-SOTELO, J., TORCHIA, M. E., O'DRISCOLL, S. W.: Complex distal humeral fractures: internal fixation with a principle-based parallel-plate technique. J. Bone Jt Surg., 89-A: 961-969, 2007.
Go to original source...
Go to PubMed...
- SCHUSTER, I., KORNER, J., ARZDORF, M., SCHWIEGER, K., DIEDERICHS, G., LINKE, B.: Mechanical comparison in cadaver specimens of three different 90-degree double-plate osteosyntheses for simulated C2-type distal humerus fractures with varying bone densities. J. Orthop. Trauma, 22: 113-120, 2008.
Go to original source...
Go to PubMed...
- SIEBENLIST, S., TORSIGLIERI, T., KRAUS, T., BURGHARDT, R. D., STOCKLE, U., LUCKE, M.: Comminuted fractures of the proximal ulna-Preliminary results with an anatomically preshaped locking compression plate (LCP) system. Injury, 41: 1306-1311, 2010.
Go to original source...
Go to PubMed...
- SMITH, G. R., HOTCHKISS, R. N.: Radial head and neck fractures: anatomic guidelines for proper placement of internal fixation. J. Shoulder Elbow Surg., 5: 113-117, 1996.
Go to original source...
Go to PubMed...
- TAN, V., DALUISKI, A., SIMIC, P., HOTCHKISS, R. N.: Outcome of open release for post-traumatic elbow stiffness. J. Trauma, 61: 673-678, 2006.
Go to original source...
Go to PubMed...
- THEIVENDRAN, K., DUGGAN, P. J., DESHMUKH, S. C.: Surgical treatment of complex distal humeral fractures: functional outcome after internal fixation using precontoured anatomic plates. J. Shoulder Elbow Surg., 19: 524-532, 2010.
Go to original source...
Go to PubMed...
- VAN DER LINDEN, S. C., VAN KAMPEN, A., JAARSMA, R. L.: K-wire position in tension-band wiring technique affects stability of wires and long-term outcome in surgical treatment of olecranon fractures. J. Shoulder Elbow Surg., 21: 405-411, 2012.
Go to original source...
Go to PubMed...
- VANDERWILDE, R. S., MORREY, B. F., MELBERG, M. W., VINH, T. N.: Inflammatory arthritis after failure of silicone rubber replacement of the radial head. J. Bone Jt Surg., 76-B: 78-81, 1994.
Go to original source...