Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Proximal Radius Fractures in Children

Introduction Pediatric fractures of the proximal radius account for 1% of all fractures in children and 4% to 10% of pediatric elbow injuries. These injuries are more likely to occur at the radial neck because of the biomechanically weaker physis in comparison to the fibrocartilaginous nature of the radial head. With increasing age and ossification of the physis, radial head injuries become more common in the…

Physeal Fractures of the Elbow

Anatomy and Growth The elbow joint consists of the articulating surfaces of three epiphyses: the distal humerus, the proximal ulna, and the proximal radius. At birth, each epiphysis is one mass of cartilage, each with its own growth plate (the physis). With growth, the distal humerus develops four ossification centers ( Fig. 29.1 ), the proximal ulna develops two, and the proximal radius develops one. The…

Complications of Supracondylar Fractures of the Elbow

Introduction Complications associated with supracondylar humerus fractures can be divided into broad categories. The etiology of a complication may be due to the injury itself or the management of the injury. The complication may be associated with the soft tissues, such as a neurovascular problem, or in the osseous structures, such as malalignment. In this chapter, we first discuss the anatomy of this area, then neurovascular…

Supracondylar Fractures of the Elbow in Children

Introduction Supracondylar humerus fractures are the most common elbow fracture in children and have the highest complication rate for elbow fractures in this age group. These compelling facts continue to arouse the interest and hold the attention of orthopedists who treat pediatric patients. Since the last edition of this text, clinical practice guidelines have been developed to guide fracture management and are included within this chapter.…

Congenital Abnormalities of the Elbow

Introduction This chapter will discuss congenital anomalies of the elbow. Any congenital abnormality must be assessed and treated with consideration for the remainder of the upper extremity, as well as the generalized condition of the patient and associated medical diagnoses. Classification and Causes of Congenital Anomalies Classification may be made according to etiology or phenotypic presentation; the abnormality may be isolated, in association with other upper…

The Pediatric Elbow: Anatomy and Radiographic Assessment

Introduction Upper extremity injuries account for the majority of pediatric fractures, with injuries to the elbow occurring with a frequency second only to radius fractures. The majority of pediatric elbow fractures occur within the distal humerus, with supracondylar humerus fractures being the most common. Fractures of the proximal radius, lateral condyle, medial epicondyle, and olecranon are also among the more common fractures seen in a child's…

Advanced and Future Trends in Elbow Arthroscopy

Introduction As with many joint advances in technology and skills, collaborations have fueled major advancements in elbow arthroscopy indications and techniques. These advances have been noted in multiple case reports and by anecdotal evidence. However, the evidence via randomized control trials of the effectiveness of elbow arthroscopy has been lacking, with most reports detailing level 4 or 5 evidence. Minimally invasive techniques are permeating orthopedics, including…

Complications of Elbow Arthroscopy

Introduction Arthroscopy of the elbow has a higher incidence of complications than any of the other joints. The proximity of the neurovascular structures and the superficial nature of the posterior lateral aspect of the joint capsule increase the usual risks associated with arthroscopy. Add to that the proclivity of the elbow to get stiff and form heterotopic ossification after even relatively minor trauma and the risks…

Arthroscopic Management of Osteochondritis Dissecans of the Capitellum

Introduction Franz Konig first described osteochondritis dissecans (OCD) lesions in 1887 as an inflammatory response that resulted in the formation of intraarticular loose bodies. We have since learned that OCD lesions do not contain inflammatory cells, but they are responsible for loose body formation. The current characterization of OCD lesions encompasses the noninflammatory, progressive separation of a discrete area of articular cartilage from underlying subchondral bone.…

Arthroscopy for Arthritis of the Elbow

Introduction Degenerative arthritis of the elbow seems to be growing more common and may be a cause of substantial disability. Although initial treatment is usually nonoperative, the arthritis often progresses and has been historically managed by open measures. Since the initial report of arthroscopic management of the degenerative elbow by Savoie et al., arthroscopy has become a more common treatment modality, with results comparable to or better…

Arthroscopic Management of Elbow Plica and Loose Bodies

Introduction Elbow arthroscopy has been utilized increasingly commonly since 1932, when Burman concluded in the Journal of Bone and Joint Surgery that the elbow joint was arthroscopically “unsuitable for examination.” In fact, it has proven to be a valuable tool in the treatment of many elbow conditions. The arthroscope has been demonstrated to be ideally suited for the removal of elbow loose bodies and is the…

Arthroscopic Management of Lateral Epicondylitis

Introduction It has been nearly 17 years since the use of the arthroscope to resect the extensor carpi radialis brevis (ECRB) tendon was introduced, and the current treatment protocol for recalcitrant lateral epicondylitis was formulated. Numerous studies demonstrating the technique involved as well as its accuracy and long-term results have been published, and this arthroscopic technique is now routinely taught in cadaveric courses in surgical learning…

General Principles of Elbow Arthroscopy

Introduction The indications for elbow arthroscopy have advanced remarkably in the past 30 years. In the past, the arthroscope was an instrument rarely used in the elbow. Originally, it was described as a tool used for diagnostic purposes, removal of loose bodies, synovectomy, and lysis of adhesions. Thorough knowledge of anatomy and increasing familiarity with arthroscopy has allowed surgeons to push the envelope to expand indications…

Examination Under Anesthesia

Introduction Since motion loss is such a major problem at the elbow, the question of manipulation is a common one. I do stretch the elbow under anesthesia, but I avoid and object to the term manipulation because I truly perform an examination of the elbow with a component that gently stretches the arc and disrupts scar and adhesions. The components of the examination are (1) to…

Splints and Bracing of the Elbow

Introduction Splints are frequently employed at the elbow to provide both static and dynamic protection and to deliver flexion or extension torque. The four most common clinical applications for braces or splints in both postoperative and postinjury management include resting and hinged splints, and dynamic and static adjustable splints. A simple classification of elbow splints that follows the clinical application has recently been proposed: (1) immobilization,…

Continuous Passive Motion

Introduction There is sound basic science support for the concept of continuous passive motion (CPM) as an adjunct for the treatment of a joint. It has been shown that this modality can promote chondrogenesis and control hematoma formation and edema after insult. Recognizing that the physiologic response to acute trauma is an inflammatory reaction characterized by swelling and inflammation that often leads to joint stiffness, the…

Principles of Elbow Rehabilitation

Introduction The goal of elbow rehabilitation is to restore optimal, pain-free function within the anatomic and physiologic limitations of the patient. To achieve this goal the clinician should adhere to several principles to guide the rehabilitation process: (1) establish a complete and accurate diagnosis, (2) control pain and inflammation, (3) implement early, atraumatic motion, (4) reestablish neuromuscular control (NMC) about the elbow, (5) rehabilitate the elbow…

General and Regional Anesthesia and Postoperative Pain Control

Introduction Orthopedic procedures for the elbow are well suited to regional anesthetic techniques. Continuous catheter techniques provide postoperative analgesia and allow early limb mobilization. In addition to intraoperative anesthesia, brachial plexus and peripheral nerve blocks may also be used in the treatment and prevention of reflex sympathetic dystrophy. Conversely, although the benefits of regional anesthesia in this patient population are well established, the operative site may…

Surgical Exposures of the Forearm

The elbow surgeon needs some familiarity with exposures of the forearm. These approaches require understanding the local anatomy because the forearm contains a number of neurovascular structures at risk during exposure. There are three clinically relevant surgical exposures for the elbow surgeon: exposure of the radius from an anterior approach (the so-called Henry exposure), exposure of the radius from a posterior approach (the so-called Thompson exposure),…

Surgical Exposures of the Elbow

Introduction Few joints require familiarity with as many surgical exposures as does the elbow. Depending on the lesion and the surgical goal, the joint and the surrounding region may be approached from the lateral, posterior, medial, or anterior direction. It is not the purpose of this chapter to discuss all of the approaches to the joint but rather to provide a comprehensive collection and critique of…