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the result of a fall.' An intercondylar fracture (i.e., T- or V-shaped

condylar fracture) is the most common distal humeral fracture in

adults. A direct impact of the ulna against the trochlea forces the

condyles apart." This is common after an MVA or high-impact fall.

Treatment consists of (1) immobilization, followed by early ROM for

a stable fracture; or (2) ORIF or total elbow arthroplasty (TEA) for

severely comminuted intra-articular fractures. Late complications

include hypomobiliry, nonunion, malunion, ulnar neuropathy, and

heterotrophic ossification.

Olecranon fractures (Figure 3-"11) result from direct trauma to a

Aexed elbow or a fall on an outstretched hand. Severe comminution

of the olecranon is associated with humeral fracture and elbow dislocation. Late complications include loss of terminal elbow extension, painful hardware, and post-traumatic arrhritis.J2

MUSCUIOSKF.I £TAL SYSTEM

187

A

B

Figure 3-10. A. hacture of the medial epIcondyle. Note the "lnar nerve nuts

ImmedIately posterior to the fracture. B. The brachial artery is at risk lit

supracondylar fractures. (W"tl1 permISSIon from A Ullwm, K Jones reds).

Emergency OrthopaedIcs and Trauma. Boston: Butterworth-Hememann,

1995;126.128.)

188

Acm'E CARE HANDBOOK FOR I'HYSICAL n-IERAPISTS

Figure 3-11. Fracture o( the olecranon. (\Vith permission (rom A Unwin, K

Jones /edsJ. Emergency Orthopaedics and Trauma. Boston: Butterworlh

Heil1emann, 1995;130.)

A fall onto an outstretched hand wirh a pronared forearm can

cause a radial head or neck fracture (Figure 3-12). Associated injuries

include elbow dislocarion and disruprion of the interosseous membrane, medial collareral l igamenr, or wrist fibrocarrilage.32 Complications of stable radial head fracture include residual pain and f. I

A

B

Figure 3-12. Fractures o( the radial neck. A. Displaced. B. Displaced and

angulated. (\'Vilh permission (rom A Unwin, K Jones reds/. Emergency

Orthopaedics and Trauma. Boslon: Buuerworth-Heinemoll1l, 1995; 130.)

MUSCULOSKEU:.IAL SYSTEM 189

hypomobility, whereas unstable radial head fractures are associated

with loss of fixation, nonunion, and painful hardware.32 Olecranon

and radial head fracture management is presented in Chapter Appendix Table 3-A.15.

Forearm Fractures

Fractures of the shaft or distal portion of the radius or ulna occur

from a wide variery of direct trauma including falls, SPOrtS injuries, or

M VAs. Owing to the high-energy impact, the fracture is usually displaced, affects an adjacent articulation, and involves a wrist or distal humeral fracture.1 Management for forearm fracture is summarized

in Chapter Appendix Table 3-A.16. Complications of forearm fracture include compartment syndrome, reflex sympathetic dystrophy, nonunion, malunion, radial nerve injury, post-traumatic arthritis, and

hypomobility of the elbow, forearm, and wrist.'·29