Injuries of Elbow and Forearm MCQs

Answer- B. Extension type most common Supracondylar humeral fractures are the most common elbow fractures in children. Most common age group affected is 5-8 years. Boys are affected more than girls. Left side is more common than right. Extension type is most common

B i.e. Cabitus Varus Malunion : - It is the commonest complication of supracondylar fracture and results in cubitus varus (Gun stock deformity). Cubitus valgus is rare and may occur occasionally in posterolateral displacement.

Answer- A. Coronoid process posterior to humerus AP view : Greater superimposition of distal humerus with proximal ulna and olecranon (normally, only terminal part of humerus is superimposed).

Answer- B. Brachial Injury to brachial artery may cause nerve and muscle ischemia (Volkmann's ischemia of flexor compartment) or may result in postischemic swelling due to edema or hemorrhage, thereby causing compartment syndrome, which can cause, if not treated immediatealy, Volkmann's ischaemic contracture later on.

The terrible triad of the elbow is a severe elbow fracture-dislocation pattern with the following features: Posterior elbow dislocation Coronoid process fracture Radial head fracture Reference: Manish kumar varshney 1st edition page no 978

A Galeazzi fracture is a fracture of the distal third of the radius with dislocation of the distal radioulnar joint. It commonly results from a fall onto an outstretched hand with the forearm in pronation. A Galeazzi fracture is an injury that requires surgical treatment. The algorithm includes anatomic reduction and fixation of the radial shaft, and closed reduction of the DRUJ with assessment of stability. If the DRUJ remains unstable, supination of the wrist may reduce the DRUJ. Otherwise, either open or closed reduction with pinning can be undertaken to stabilize the joint. The closer the radius fracture is to the DRUJ, the more likely it is to be unstable. Acute intervention results in improved outcomes as compared to delayed reconstruction. Reference: Maheshwari ortho 5th edition page no 111

The combination of valgus, axial, and posterolateral rotatory forces (forearm supination) can result in a "terrible triad" injury of the elbow. The key features of a terrible triad injury include a radial head fracture, coronoid fracture, and dislocation of the elbow. Disruption of the lateral collateral ligament complex often concomitantly occurs. While restoration of the bony anatomy is important for static stability, the key primary stabilizer that needs to be addressed is the lateral collateral ligament complex. In acute injuries LCL repair may be possible. In chronic injury, LCL reconstruction would need to be considered. Reference- Manish Kumar Varshney 1 st edition, page number 979

Weakness of flexion of elbow and sensory loss over the lateral aspect of forearm is seen in Musculocutaneous N injury. This occurs due to the palsy of Brachialis and Biceps which are supplied by the Musculocutaneous nerve. The Lateral cutaneous N of forearm is also a branch of Musculocutaneous N, hence the sensory loss. Musculocutaneous N is the second most commonly injured nerve in shoulder dislocation after the Axillary N. Reference: Koval's Handbook of fracture's 5th edition, page no. 173