Skip to content

Trauma & Fractures

Elbow & forearm trauma: fracture patterns, pediatric/adult differences, and management of associated nerve/compartment risks.

Overview

Effective fracture management requires a comprehensive understanding of common fracture types, evaluation methods, treatment options, and expected complications to prevent adverse outcomes [1]. Care must be tailored to the patient rather than dictated solely by the injured bone, as major surgery to stabilize fractures carries a higher complication rate in patients whose hypovolemic shock is not fully corrected [31]. Fracture pattern, location, and identifiable patient risk factors may predict poor outcomes with nonoperative management, suggesting that earlier operative intervention may be recommended [2].

Indications for surgical treatment vary by anatomical site and fracture morphology. Operative treatment is generally indicated for displaced isolated avulsion fractures of the lesser tuberosity of the humerus [32]. Surgical intervention for humeral shaft and distal humerus fractures is indicated for specific absolute and relative indications, with plate fixation and intramedullary nailing being primary options that carry distinct complication profiles [33]. For displaced midshaft clavicle fractures, selection of the surgical approach should depend on fracture morphology, surgeon preference, and patient-specific factors [88]. Indications for surgical treatment of finger fractures are more clearly defined, though results vary according to fracture type, surgeon experience, and patient compliance [69].

Outcomes are generally satisfactory when specific principles are followed. Overall outcomes of treatment for distal humerus intra-articular fractures are generally quite satisfactory when specific principles are followed during the procedure [24]. The success of operative treatment for anterior fracture-dislocation of the proximal interphalangeal joint was attributed to essentially anatomical replacement of both fracture fragments [21]. Conservative treatment may be considered for nondisplaced subtype 1 and 2 anteromedial coronoid facet fractures under strict preconditions, as these show satisfactory functional outcomes when treated nonoperatively [10]. However, most randomized controlled trials on surgical management of proximal humerus fractures lack consensus in inclusion criteria and do not include patient-specific variables beyond age [23]. Additionally, the risk of intraoperative periprosthetic femoral fractures during primary total hip arthroplasty increases in patients younger than 50 years, older than 80 years, females, those with American Society of Anesthesiologists grade 3 to 5, and those with indications other than primary osteoarthritis [29].

Anatomy & Pathophysiology

Osseous Articulations and Stability

Restoration of elbow function requires recognition of the complex articulations of the humerus, radius, and ulna [41]. Simple dislocations of the elbow involve highly congruent joints with inherent stability provided by bony structures and dynamic stabilizers [83]. Insertion of a correctly sized metallic radial head replacement recreates near-normal biomechanics of the forearm with no change in the loading characteristics of the interosseous membrane [54].

Ligamentous and Dynamic Stabilizers

Restoration of elbow function requires recognition of the critical role of ligaments and dynamic stabilizers in the elbow joint [41]. Overhead elbow extension results in kinematics similar to those of an intact elbow in elbows with medial collateral ligament (MCL) and lateral collateral ligament (LCL) tears [42]. Ulnar collateral ligament reconstruction using a suspension button fixation technique reliably restores elbow kinematics to the intact state [49]. Both posterolateral and posteromedial rotatory instability directions must be addressed surgically to restore elbow stability [57]. Recognizing the precise pattern of injury is critical in restoring elbow function and preventing chronic instability, pain, and weakness in complex elbow instability [59].

Kinematics and Injury Mechanisms

Understanding elbow biomechanics and injury mechanisms provides insight into variations of pathology observed in complex elbow dislocations [35]. Valgus torque at the elbow during baseball pitching is associated with six biomechanical variables of sequential body motion [46]. Increased medial elbow torque in youth baseball pitchers is associated with greater ball velocity regardless of the history of medial elbow injuries [50]. Elbow valgus torque is poorly suited as a standalone metric for predicting injury risk due to narrow data ranges, modeling noise, and crude assumptions [52]. Future efforts to predict injury risk should focus on integrated, longitudinal metrics rather than single-session proxies like valgus torque [52]. Reconstruction of chronically dislocated elbows requires combining an understanding of anatomy and biomechanics with surgical technique to achieve functional and painless joints [38].

Classification

Understanding common fracture types, evaluation methods, treatment options, and expected complications is critical for surgeons to avoid adverse outcomes [1].

Gustilo-Anderson: This classification of open fractures directs the treating surgeon’s attention to the presence and extent of injury variables [6]. The Gustilo-Anderson classification type is the factor most strongly associated with the development of deep infection and nonunion in open fractures of the radius and/or ulna [45]. While some authors have used the Gustilo classification to create alternative classifications, these have not gained traction [53]. Other contemporaneous literature has modified the Gustilo-IIIB subtypes to better stratify functional and reconstructive outcomes following vascular injury [53].

Tibial Plateau: A proposed classification system for tibial plateau fractures based on injury mechanism and morphological characteristics has instructive significance for preoperative evaluation of fracture features and soft tissue problems, and guides clinical management for better functional outcomes [9].

Elbow Fracture-Dislocations: The Wrightington classification system is a reliable and valid method of classifying fracture-dislocations of the elbow [25]. A new comprehensive classification system for elbow fracture dislocations based on the three-column concept is presented with a suggested algorithm for managing each injury pattern [36]. Correct identification, classification, and understanding of Monteggia-like lesions of the elbow using CT scans, followed by appropriate surgical treatment that addresses all components of the injury, can achieve good to excellent mid-term results [14].

Olecranon Stress Fractures: A new classification for olecranon stress fractures in baseball players is based on the origin and direction of the fracture plane, which is strongly influenced by the age at symptom onset [37]. Operative indications for each type of olecranon stress fracture identified in the new classification system are an important next step for future study [40].

Proximal Humerus: A new classification for displaced proximal humeral fractures based on the displacement of the four major segments (head, lesser tuberosity, greater tuberosity, and shaft) is adequate for sorting lesions and correlating roentgen appearance with fracture type [48]. Most randomized controlled trials on surgical management of proximal humerus fractures do not include patient-specific variables within their inclusion and exclusion criteria, besides age [23].

Hip Fractures: Deep learning models have shown great potential in assisting clinicians with the accurate diagnosis and classification of hip fractures [13].

Clinical Presentation

History and Mechanism: Musculoskeletal injuries are the most common reported injuries in all-terrain vehicle (ATV) accidents, with lower extremity fractures being the most frequent [43]. Understanding the clinical characteristics of multiple ligament knee injury (MLKI) patterns supports clinical decision-making and individualized treatment [39]. The classification of open fractures directs the attention of the treating surgeon to the presence and extent of injury variables [6]. A classification system for tibial plateau fractures based on injury mechanism and morphological characteristics guides preoperative evaluation of fracture features and soft tissue problems [9].

Inspection and Imaging: Fracture pattern, fracture location, and identifiable patient risk factors may predict poor outcome with nonoperative management of humeral shaft fractures [2]. Stress fractures of the radius diaphysis in skeletally immature wrestlers are often subtle or undetectable on plain radiographs, requiring a high index of suspicion for diagnosis [7]. Accurate identification of partial avulsion patterns in pediatric humeral medial epicondyle injuries is important for understanding their natural history and treatment outcomes [12]. Deep learning models show potential in assisting clinicians with the accurate diagnosis and classification of hip fractures [13]. Increasingly sophisticated imaging and modeling leads to slight but significant improvements in diagnostic performance characteristics and interobserver agreement on distal humerus fracture characteristics [19].

Palpation and Stability: Distal triceps tendon rupture is rare in skeletally immature pediatric patients [44]. Treatment of pediatric humeral shaft fractures should be predicated on a full evaluation of the patient, fracture, local soft tissues, and any concomitant injuries [16]. Patients older than 65 years with coronal fractures of the capitellum have no substantial risk of complex fracture patterns but have a large number of concomitant injuries [3].

Red-Flag Patterns: Radial head or neck fractures in children necessitate close observation for signs and symptoms of compartment syndrome during the first twenty-four to forty-eight hours after injury [4]. Clinical outcomes for post-traumatic stiffness after elbow fracture are worse in intra-articular fractures compared to extra-articular fractures [22]. Delayed fixation of neglected acetabular fractures achieved satisfactory anatomical and functional results in most cases [17]. The total count of nearly every evaluated upper extremity fracture type increased over the past 15 years in Germany [18].

Investigations

Plain radiography: A high index of suspicion is required to diagnose stress fractures of the radius diaphysis in skeletally immature wrestlers because they are often subtle or undetectable on plain radiographs [7]. Accurate interpretation of plain radiographs for the avulsion fleck sign can lead to a faster diagnosis of triceps tendon avulsions in children and young adult patients [92]. Evaluation with radiographic examination or bone scan is indicated for acute transverse patellar fractures associated with weightlifting [90]. Computed tomographic scanning is valuable for diagnosing fracture of the atlantal arch causing atlanto-axial instability when plain radiographs are inconclusive [97].

MRI: MRI is essential for the accurate diagnosis of stress fractures of the upper limb as it allows precise grading of the injury and determination of the rest period needed for healing [103]. MRI is used for nondisplaced Jones fractures in elite athletes [30]. Ultrasound and MRI are helpful in evaluating acute traumatic brachialis rupture and monitoring its resolution [77]. MRI should be performed if healing does not occur by a reasonable time despite successful bony healing to assess potential cartilage damage in osteochondritis dissecans of the capitellum [87]. Early orthopaedic referral and early MRI may help prevent delay in diagnosis and allow expedient surgical intervention in appropriate candidates for pectoralis major avulsion in skeletally immature wrestlers [96]. Advanced imaging is indicated to fully assess triceps tendon avulsions in children and young adult patients [92]. The time interval from injury to MRI is relevant to the diagnosis of injury to the Kaplan fibers of the iliotibial band in association with anterior cruciate ligament injury, with significantly higher rates of injury identification in patients with early (within 90 days) versus delayed (≥90 days) MRI [94]. Magnetic resonance imaging is generally recommended with respect to associated soft-tissue injuries, especially in cases with distinct tibial plateau fracture depression on multi-detector computed tomography scans [99].

CT: CT scans enable correct identification, classification, and understanding of Monteggia-like lesions of the elbow to guide appropriate surgical treatment [14]. CT is used for comminuted or displaced Jones fractures in elite athletes [30]. The nature of non-operatively treated fractures of the anteromedial facet of the coronoid process can be most reliably documented using computed tomography with three-dimensional reconstructions [93]. CT is recommended for improved characterization of any fracture with a coronoid component in proximal ulna fracture-dislocations of the elbow [95]. High-resolution CT should be considered for patients with Mason II radial head fractures to appropriately indicate treatment options [101].

Bone scan: Evaluation with radiographic examination or bone scan is indicated for acute transverse patellar fractures associated with weightlifting [90].

Other Considerations: Increasingly sophisticated imaging and modeling leads to slight but significant improvements in diagnostic performance characteristics and interobserver agreement on fracture characteristics of distal humerus fractures [19]. Advances in understanding fracture patterns, imaging, exposure techniques, fixation, and rehabilitation have improved patient outcomes for distal humerus fractures [20]. The Wrightington classification system is a reliable and valid method of classifying fracture-dislocations of the elbow [25]. CT scans are more accurate to identify the injury pattern and have higher intra and inter observer reproducibility for the Wrightington classification of elbow fracture dislocation [100]. More sophisticated images and modeling improved reliability but not accuracy when characterizing coronoid fractures [102].

Treatment

Non-Operative

Conservative management is appropriate for specific fracture patterns and patient populations. Nondisplaced subtype 1 and 2 anteromedial coronoid facet fractures show satisfactory functional outcomes under strict preconditions [10]. Routine primary nonoperative management of isolated stable radial head fractures provides satisfactory outcomes for the majority, with few requiring further intervention [11]. Nondisplaced or minimally displaced acute proximal humeral fractures in adults are managed with initial immobilization and rehabilitation [47]. Nondisplaced capitellar fractures in children and adolescents heal successfully with cast immobilization [65]. A patient treated nonoperatively for complete non-union of radial neck fracture achieved a good functional outcome at 16 months with no pain, avascular necrosis, or head collapse [70]. Non-surgical treatment for olecranon fractures was predominant across all ages but decreased markedly in older patients [72]. Athletes conservatively managed for clavicular fractures returned to sport 40% faster than those with surgery, though this appears associated with the severity and complexity of fractures treated surgically [73]. Nonoperative management is an acceptable treatment for supracondylar process fractures of the humerus in adolescent athletes when there are no signs of neurovascular compromise [76]. The role of non-operative management for pelvic and acetabular fractures remains undefined, with early functional results appearing favorable but late posterior pain incompletely solved [79].

Operative

Indications: Fracture pattern, location, and identifiable patient risk factors may predict poor outcome with nonoperative management of humeral shaft fractures, recommending earlier operative intervention [2]. Treatment of pediatric humeral shaft fractures should be predicated on a full evaluation of the patient, fracture, local soft tissues, and any concomitant injuries [16]. Operative treatment is generally indicated for isolated avulsion fracture of the lesser tuberosity of the humerus in the case of displaced fracture [32]. Surgical intervention for humeral shaft and distal humerus fractures is indicated for specific absolute and relative indications [33]. Displaced or unstable proximal humeral fractures are managed operatively [47]. Surgical treatment for proximal humeral fracture with avulsion fracture of the lesser tuberosity in an adolescent girl is favored only with greatly displaced fractures or if nonsurgical treatment fails [84]. In patients aged > 75 years, operative management is preferred by most respondents for simple and comminuted olecranon fractures [86]. Fracture care should be tailored to the patient rather than dictated by the injured bone, as major surgery to stabilize fractures carries a higher complication rate when performed on patients whose hypovolemic shock is not fully corrected [31].

Surgical Approach / Technique: Operative treatment success for anterior fracture-dislocation of the proximal interphalangeal joint was attributed to essentially anatomical replacement of both fracture fragments [21]. Minimally invasive techniques utilizing the “Joy Stick” method for managing irreducible flexion-type supracondylar fractures of the humerus in older children offer substantial stability and result in excellent long-term recovery of joint function [27]. Excellent outcomes with open reduction internal fixation of acromion fracture with open rotator cuff repair are encouraging for further use of this treatment approach for traumatic acromion fractures [64]. Optimal outcomes in the treatment of forearm fracture–dislocations depend on early recognition and management, with restoration and maintenance of anatomic alignment being key principles [75].

Implant Selection: One-year mortality rate for stable and unstable trochanteric and subtrochanteric fractures was lower in patients treated with intramedullary nail compared to sliding hip screw [56]. Use of plate fixation for surgically managed olecranon fractures increased, while tension-band wiring use decreased in popularity [72]. Plate fixation and IM nailing are primary options for humeral shaft and distal humerus fractures, each carrying distinct complication profiles [33]. Megaprosthetic replacement for complex distal humerus fractures in elderly patients is a salvage procedure with a narrowed indication, as failure would cause even more complex situations [91].

Alignment / Balancing Strategy: Overall outcomes of treatment for distal humerus intra-articular fractures are generally quite satisfactory when specific surgical principles are followed [24].

Pain Management: Clinical outcomes for post-traumatic stiffness after elbow fracture were worse in the intra-articular fracture group compared to the extra-articular fracture group [22].

Adjuncts: Risk of intraoperative periprosthetic femoral fractures during primary total hip arthroplasty increases in patients younger than 50 and older than 80 years, females, those with American Society of Anesthesiologists grade 3 to 5, and indications other than primary osteoarthritis [29].

Other Considerations: Surgeons must understand common fracture types, evaluation methods, treatment options, and expected complications to avoid adverse outcomes [1]. Only a few studies with a low level of evidence address the treatment of isolated, displaced, partial articular Mason Type II radial head fractures without associated fractures or elbow dislocation [80].

Complications

Surgeons must understand expected complications to avoid adverse outcomes in knee trauma [1]. Musculoskeletal injuries generate some of the highest rates of long-term disability [68].

Periprosthetic fracture: Periprosthetic fractures around the shoulder are complex injuries with defined epidemiology, risk factors, and management considerations [5]. There is no significant difference in long-term mortality or reoperation rates between early (< 48 hours) and late (> 48 hours) surgery for periprosthetic proximal femoral fractures [28].

Geriatric Hip Fracture: Geriatric hip fractures continue to have high short-term morbidity and mortality [15]. Preoperative comorbidities are associated with early mortality in hip fracture patients [15]. Associated fractures in proximal humerus fractures are linked to increased mortality and length of stay [66].

Distal Femur Fracture: Closed fracture status and regular follow-up are determining factors for better functional outcomes in distal femur fractures treated with open reduction and internal fixation using a distal femur locking plate [8].

Pediatric Trauma: Radial head or neck fractures in children necessitate close observation for compartment syndrome during the first twenty-four to forty-eight hours after injury [4]. Accurate identification of partial avulsion patterns in pediatric humeral medial epicondyle injuries is important for understanding natural history and treatment outcomes [12].

Other Considerations: Patients older than 65 years with coronal fractures of the capitellum have a large number of concomitant injuries [3]. First rib fractures causing thoracic outlet syndrome require careful follow-up due to the risk of nonunion [26]. Distal biceps short head tears have a poor natural history akin to complete tears [34]. Complications are frequent after supracondylar ostectomy and shortening for distal humerus nonunions, with worse outcomes for patients with intra-articular nonunions [71]. Complication rates, including deep infection and nonunion, are high after transolecranon distal humerus fracture, with frequent long-term functional limitations [74]. In England, the incidence of open fractures increased with age in females to a much greater level than observed in older males [98]. Nursing care becomes easier for patients with fibrodysplasia progressiva ossificans and humeral fracture because bony union is virtually guaranteed [104].

Recovery

Light activity (weeks): Specific timelines for light activity are not defined in the current evidence base. However, early operative intervention may be recommended for humeral shaft fractures when risk factors for poor nonoperative outcomes are present [2]. For children with radial head or neck fractures, close observation for signs and symptoms of compartment syndrome is necessary during the first twenty-four to forty-eight hours after injury [4].

Full activity (months): Long-term outcome with surgical management of complex elbow injuries is unknown [85]. Minimally invasive techniques utilizing the “Joy Stick” method for irreducible flexion-type supracondylar fractures of the humerus in older children offer substantial stability and result in excellent long-term recovery of joint function [27].

Complete recovery / outcome plateau (months): Bony remodelling cannot be relied upon to correct residual deformity in childhood supracondylar humeral fractures [60]. Type II childhood supracondylar humeral fractures have impaired long-term recovery [60]. Longer follow-up is needed to determine the durability and long-term outcomes of fixation versus joint replacement for displaced femoral neck fractures in workers’ compensation patients aged 45-65 years [62].

Rehabilitation protocol: The evidence does not specify standardized rehabilitation protocols, immobilisation durations, or weight-bearing progressions for the included fracture types.

Functional milestones: Validated PROM trajectories or outcome-measure benchmarks are not provided in the current evidence base.

Other Considerations: Fracture pattern, fracture location, and identifiable patient risk factors may predict poor outcome with nonoperative management of humeral shaft fractures [2]. Patients older than 65 years with coronal fractures of the capitellum have a large number of concomitant injuries [3]. Closed fracture status and regular follow-up are determining factors for better functional outcomes in distal femur fractures treated by open reduction and internal fixation using a distal femur locking plate [81]. Geriatric hip fractures continue to have high short-term morbidity and mortality [15]. Open reduction and internal fixation achieves satisfactory anatomical and functional results in most cases of neglected acetabular fractures despite delayed presentation [17]. First rib fractures causing thoracic outlet syndrome should be followed-up carefully [26]. There is no significant difference in long-term mortality or reoperation rates between early (< 48 hours) and late (> 48 hours) surgery for periprosthetic proximal femoral fractures [28]. The 2025 international consensus recommends MRI for nondisplaced Jones fractures, CT for comminuted or displaced Jones fractures, and specifies indications for minimally invasive techniques and adjunctive bone grafting [30]. Distal biceps short head tears present acutely, have a poor natural history akin to complete tears, and have good outcomes with acute and delayed reconstruction [34]. Close follow-up of nonoperatively treated clavicle fractures is warranted due to displacement related to patient position and progressive displacement in the peri-injury period [81]. Upper-extremity injuries in polytrauma patients are associated with a longer hospitalization, longer intensive care unit stay, reduced mortality rate, and a minor increase in long-term disability [89]. Delayed bone union in young baseball players with humeral medial epicondylar fragmentation is associated with resumption of throwing at maximum strength before bone union had occurred [105]. Patients with open humeral shaft fractures treated by minimally invasive plate osteosynthesis are six times more likely to progress to non-union [106]. Treatment of a fracture and increased operative time are risk factors for all patients undergoing total elbow arthroplasty for fracture and arthropathy [107]. Outpatient status is protective against adverse events following total elbow arthroplasty for fracture and arthropathy [107].

Key Evidence

  • [L5] Fracture pattern, fracture location, and identifiable patient risk factors may predict poor outcome with nonoperative management, and earlier operative intervention may be recommended. (10.1016/j.jse.2017.10.028)
  • [L4] Patients older than 65 years have no substantial risk of complex fracture patterns, but they have a large number of concomitant injuries. (10.1016/j.jse.2015.12.004)
  • [L4] These seemingly innocuous fractures necessitate close observation for the signs and symptoms of a compartment syndrome during the first twenty-four to forty-eight hours after the injury. (10.2106/00004623-199507000-00014)
  • [L4] This article represents a detailed review of the epidemiology, risk factors, classification and management of these complex injuries. (10.1111/j.1758-5740.2011.00147.x)
  • [L5] The classification of open fractures is important because it directs the attention of the treating surgeon to the presence and extent of injury variables. (10.5435/00124635-200305000-00008)
  • [L4] A high index of suspicion is required to diagnose these fractures because they are often subtle or undetectable on plain radiographs. (10.1016/j.jhsa.2012.01.040)
  • [L3] Closed fracture and regular follow up were determining factors for better functional outcomes. (10.1186/s13018-024-05054-7)
  • [L4] The proposed classification system based on injury mechanism and morphological characteristics has instructive significance for preoperative evaluation of fracture features and soft tissue problems, and guides clinical management for better functional outcomes. (10.1186/s13018-019-1321-8)
  • [L4] Conservative treatment may be considered under strict preconditions, especially for nondisplaced subtype 1 and 2 fractures, as these fractures show satisfactory functional outcomes when treated nonoperatively. (10.1016/j.jse.2020.09.008)
  • [L4] Routine primary nonoperative management of these fractures provides a satisfactory outcome for the majority of patients, with few patients requiring further intervention for persisting complaints. (10.2106/jbjs.m.01354)
  • [L4] Accurate identification of these injury patterns and their underlying pathology is likely important for understanding the natural history of these injuries and the outcomes of different treatment strategies. (10.1177/03635465241310407)
  • [L4] The model has shown great potential in assisting clinicians with the accurate diagnosis and classification of hip fractures. (10.1302/0301-620x.107b2.bjj-2024-0791.r1)
  • [L3] With correct identification, classification, and understanding using CT scans followed by appropriate surgical treatment that addresses all components of the injury, good to excellent mid-term results can be achieved. (10.1302/0301-620x.100b2.bjj-2017-0398.r2)
  • [L3] Geriatric hip fractures continue to have high short-term morbidity and mortality. (10.5435/jaaos-d-21-01055)
  • [L5] Overall, treatment should be predicated on a full evaluation of the patient, fracture, local soft tissues, and any concomitant injuries. (10.5435/jaaos-d-22-00443)
  • [L3] Despite delayed presentation, ORIF achieved satisfactory anatomical and functional results in most cases. (10.1186/s13018-025-06298-7)
  • [L4] Total count of nearly every evaluated fracture increased. (10.1186/s13018-020-1580-4)
  • [L1] Increasingly sophisticated imaging and modeling leads to slight but significant improvements in diagnostic performance characteristics and interobserver agreement on fracture characteristics. (10.1016/j.jse.2012.01.009)
  • [Case_report] The success of the operative treatment was attributed to essentially anatomical replacement of both fracture fragments. (10.2106/00004623-197961050-00025)
  • [L3] The clinical outcomes in the intra-articular fracture group as a previous trauma were worse than those in the extra-articular fracture group. (10.1016/j.jse.2019.06.008)
  • [L2] Besides age, most RCTs on surgical management of proximal humerus fractures do not include patient-specific variables within their inclusion and exclusion criteria. (10.1016/j.xrrt.2025.07.023)
  • [L5] Given that these principles are followed during the procedure, the overall outcomes of treatment for intra-articular fracture are generally quite satisfactory. (10.5397/cise.2019.22.2.113)
  • [L4] The Wrightington classification system is a reliable and valid method of classifying fracture-dislocations of the elbow. (10.1302/0301-620x.102b8.bjj-2020-0013.r1)
  • [Case_report] Therefore, this type of fracture should be followed-up carefully. (10.1016/j.jse.2010.03.011)
  • [L4] This technique offers substantial stability for the fracture and results in excellent long-term recovery of joint function. (10.1186/s13018-024-04922-6)
  • [L3] This study found no significant difference in long-term mortality or reoperation rates between patients undergoing early (< 48 hours) or late (> 48 hours) surgery for PPF fractures. (10.1016/j.arth.2025.07.009)
  • [L3] Fracture risk increases in patients younger than 50 and older than 80 years, females, American Society of Anesthesiologists grade 3 to 5, and indications other than primary osteoarthritis. (10.1016/j.arth.2019.06.062)
  • [L5] The consensus process reached unanimous agreement with respect to the use of MRI for nondisplaced fractures, the use of CT for comminuted or displaced fractures, indications for minimally invasive techniques, and use of adjunctive bone grafting. (10.1002/ksa.70241)
  • [L5] Fracture care should be tailored to the patient, not dictated by the injured bone, as major surgery to stabilize fractures carries a higher complication rate when performed on patients whose hypovolemic shock is not fully corrected. (10.5435/00124635-200503000-00002)
  • [L4] Operative treatment is generally indicated in the case of displaced fracture. (10.1016/j.jseint.2020.04.010)
  • [L4] They present acutely, have a poor natural history akin to complete tears, and have good outcomes with acute and delayed reconstruction. (10.1016/j.jse.2020.04.038)
  • [L4] Understanding elbow biomechanics and the injury mechanism provides valuable insight into the variations of pathology that may be observed. (10.5435/jaaos-d-14-00023)
  • [L5] A new comprehensive classification system based on the three-column concept is presented with a suggested algorithm for managing each injury pattern. (10.1177/1758573219884010)
  • [L4] This study presents a new classification system for the different types of OSFs based on the origin and direction of the fracture plane, which is strongly influenced by the age at symptom onset. (10.1177/0363546514528099)
  • [L4] By combining an understanding of anatomy and biomechanics with surgical technique, the authors could reconstruct chronically dislocated joints to achieve functional and painless elbows. (10.1016/j.jse.2006.09.003)
  • [L4] A better understanding of the clinical characteristics and management of the various MLKI patterns can be used to support clinical decision-making and individualized treatment of these complex injuries, and may ultimately lead to enhanced outcomes and reduced associated risks. (10.2106/jbjs.20.02051)
  • [L5] The study was intended to introduce a classification system for olecranon stress fractures, with operative indications for each type identified as an important next step for future study. (10.1177/0363546514541043)
  • [L5] Overhead elbow extension results in similar kinematics between an intact elbow and an elbow with MCL and LCL tears. (10.1016/j.jht.2022.01.008)
  • [L4] Musculoskeletal injuries are the most common reported injuries in ATV accidents, with lower extremity fractures being the most frequent; orthopaedic surgeons play a pivotal role in the prevention, diagnosis, and management of these often life-threatening injuries. (10.5435/00124635-201104000-00006)
  • [Case_report] This case highlights the rarity of the injury in skeletally immature patients and the successful outcome of operative management. (10.1016/j.jse.2006.06.002)
  • [L3] The type of fracture as outlined by the Gustilo-Anderson classification was the factor most strongly associated with the development of deep infection and nonunion in these fractures. (10.1016/j.jhsa.2014.02.008)
  • [L4] Valgus torque at the elbow during baseball pitching is associated with 6 biomechanical variables of sequential body motion. (10.1177/0363546509336721)
  • [L5] In case of nondisplaced or minimally displaced fractures, a conservative treatment, consisting of initial immobilization and a rehabilitation program will be chosen, while displaced or unstable fractures will be managed operatively. (10.1016/j.jht.2017.05.005)
  • [L4] A new classification based on the displacement of the four major segments (head, lesser tuberosity, greater tuberosity, and shaft) is adequate for sorting lesions and correlating roentgen appearance with fracture type. (10.1097/01.blo.0000198718.91223.ca)
  • [L5] Ulnar collateral ligament reconstruction using a suspension button fixation technique reliably restored elbow kinematics to the intact state. (10.1177/0363546509350109)
  • [L2] Increased medial elbow torque was associated with greater ball velocity regardless of the history of medial elbow injuries. (10.1016/j.arthro.2022.07.016)
  • [L5] Elbow valgus torque is poorly suited as a standalone metric for predicting injury risk due to narrow data ranges, modeling noise, and crude assumptions; future efforts should focus on integrated, longitudinal metrics rather than single-session proxies. (10.1002/arj.70098)
  • [L4] Some authors have used the Gustilo classification to create alternative classifications, but these have not gained traction, while other contemporaneous literature has modified the Gustilo-IIIB subtypes to better stratify functional and reconstructive outcomes following vascular injury. (10.2106/jbjs.18.00342)
  • [L5] Insertion of a correctly sized metallic radial head replacement recreates near normal biomechanics of the forearm with no change in the loading characteristics of the interosseous membrane. (10.1302/0301-620x.95b10.31844)
  • [L2] One-year mortality rate for unstable and stable fractures was lower in patients treated with IMN. (10.1302/0301-620x.104b2.bjj-2021-1078.r1)
  • [L4] Both directions of instability must be addressed surgically to restore elbow stability. (10.1016/j.injury.2007.01.039)
  • [Paper] Recognising the precise pattern of injury is critical in restoring elbow function and preventing chronic instability, pain and weakness. (10.1016/j.injury.2013.09.032)
  • [L3] Bony remodelling cannot be relied upon to correct residual deformity, and type II fractures have impaired long-term recovery. (10.1302/0301-620x.98b10.35923)
  • [L3] Longer follow-up will help determine the durability and long-term outcomes of these surgeries. (10.1016/j.arth.2020.06.003)
  • [Case_report] The excellent outcome in this patient is encouraging for further use of this treatment approach when dealing with traumatic acromion fractures. (10.1016/j.jseint.2020.03.004)
  • [L4] Nondisplaced fractures heal successfully with cast immobilization, while displaced Type-I fractures may achieve good results with surgical fixation, and Type-II and Type-III fractures require advanced imaging and timely surgical management to optimize clinical results. (10.2106/jbjs.16.01393)
  • [L4] Associated fractures were frequent and linked to increased mortality and length of stay, highlighting the burden of these injuries on the healthcare system. (10.1016/j.jseint.2021.12.003)
  • [L4] Musculoskeletal injuries are expensive and generate some of the highest rates of long-term disability, with nearly 75% of all injuries caused by explosive mechanisms and fractures comprising 40% of all musculoskeletal injuries. (10.5435/jaaos-d-15-00123)
  • [L5] Fractures of the fingers are better understood, indications for surgical treatment are more clearly defined, and operative techniques and implants for osteosynthesis are continuing to evolve and improve, though results vary according to fracture type, surgeon experience, and patient compliance. (10.1054/jhsb.2002.0889)
  • [Case_report] The patient was treated nonoperatively despite complete non-union and achieved a good functional outcome at 16 months with no pain, avascular necrosis, or head collapse. (10.1111/j.1758-5740.2010.00080.x)
  • [L4] However, complications were frequent, and outcomes were worse for patients with intra-articular nonunions. (10.1016/j.jse.2024.05.004)
  • [L3] Non-surgical treatment was predominant across all ages but decreased markedly in older patients, while plate fixation use increased and tension-band wiring use decreased in popularity for surgically managed fractures. (10.1186/s13018-025-05970-2)
  • [L4] Athletes conservatively managed returned 40% faster than those with surgery, though this appears to be associated with the severity and complexity of fractures treated surgically. (10.1016/j.jse.2021.04.006)
  • [L4] Complication rates, including deep infection and nonunion, are high, with frequent long-term functional limitations posed to the patient. (10.1016/j.jse.2020.07.012)
  • [L5] Optimal outcomes in the treatment of forearm fracture–dislocations depend on early recognition and management, with restoration and maintenance of anatomic alignment being the key principles. (10.1016/j.hcl.2015.01.010)
  • [L4] Nonoperative management is an acceptable treatment for supracondylar process fractures when there are no signs of neurovascular compromise. (10.1016/j.jseint.2020.07.011)
  • [Letter] Ultrasound and MRI are helpful in evaluating this injury and monitoring its resolution. (10.1016/j.jse.2013.01.016)
  • [L5] The early functional results appear favorable; however, the role of non-operative management is not defined, and the problem of late posterior pain in patients with a pelvic fracture is incompletely solved. (10.2106/00004623-198668080-00035)
  • [L4] Only a few studies with a low level of evidence address the treatment of isolated, displaced, partial articular fractures. (10.1016/j.jhsa.2012.03.042)
  • [L2] Close follow-up of nonoperatively treated clavicle fractures is warranted. (10.1016/j.jse.2018.01.004)
  • [L5] Simple dislocations of the elbow are highly congruent joints with inherent stability provided by bony structures and dynamic stabilizers, allowing for early active range of motion during rehabilitation. (10.1016/j.hcl.2004.07.002)
  • [Case_report] Surgical treatment is only favored with greatly displaced fractures or if nonsurgical treatment fails. (10.1016/j.jse.2015.05.054)
  • [L5] Long-term outcome with surgical management of complex elbow injuries is unknown. (10.5435/00124635-200605000-00003)
  • [L4] In patients aged > 75 years, operative management is again preferred by most respondents for simple and comminuted fractures. (10.1016/j.jseint.2023.10.009)
  • [Case_report] The authors recommend performing an MRI if healing does not occur by a reasonable time despite successful bony healing to assess potential cartilage damage. (10.1007/s00402-005-0018-0)
  • [L1] Selection of the surgical approach should depend on fracture morphology, surgeon preference, and patient-specific factors. (10.5397/cise.2025.01179)
  • [L3] Upper-extremity injuries in polytrauma patients are associated with a longer hospitalization, longer intensive care unit stay, and reduced mortality rate, as well as a minor increase in long-term disability. (10.1016/j.jse.2021.10.005)
  • [L4] Evaluation with radiographic examination or bone scan is indicated, and reduction of training load may prevent acute fracture. (10.1177/03635465010290021901)
  • [L4] The indication for this type of treatment must be selected and narrowed down, as it is a salvage procedure, and any failure would cause even more complex situations. (10.1186/s13018-023-04465-2)
  • [L4] Accurate interpretation of plain radiographs for the avulsion fleck sign can lead to a faster diagnosis, though advanced imaging is indicated to fully assess the injury. (10.1016/j.jse.2025.02.031)
  • [L4] The nature of the injury can be most reliably documented using computed tomography with three-dimensional reconstructions. (10.1111/j.1758-5740.2009.00044.x)
  • [L3] However, the time interval from injury to MRI was relevant to diagnosis, with significantly higher rates of injury identification in patients with early (within 90 days) versus delayed (≥90 days) MRI. (10.1177/0363546520931854)
  • [L4] CT is recommended for improved characterization of any fracture with a coronoid component. (10.1016/j.jseint.2023.11.008)
  • [L4] Early orthopaedic referral and early MRI may help prevent delay in diagnosis and allow expedient surgical intervention in appropriate candidates. (10.1177/0363546509351559)
  • [L4] Computed tomographic scanning is valuable for diagnosing this pathology when plain radiographs are inconclusive. (10.2106/00004623-198668080-00024)
  • [L3] While most open fractures occurred in young males, the incidence increased with age in females to a much greater level than observed in older males. (10.1302/0301-620x.104b6.bjj-2021-1097.r2)
  • [L4] Magnetic resonance imaging is generally recommended with respect to associated soft-tissue injuries, especially in cases with distinct tibial plateau fracture depression on multi-detector computed tomography scans. (10.1007/s00167-012-2201-5)
  • [L3] CT scans are more accurate to identify the injury pattern and have higher intra and inter observer reproducibility. (10.1016/j.jse.2021.03.099)
  • [L3] High-resolution CT should be considered for patients with Mason II radial head fractures to appropriately indicate treatment options. (10.1016/j.jseint.2021.04.012)
  • [L2] More sophisticated images and modeling improved reliability but not accuracy when characterizing coronoid fractures. (10.1016/j.jse.2013.02.009)
  • [L4] MRI is essential for the accurate diagnosis in stress fractures of the upper limb as it allows precise grading of the injury and determination of the rest period needed for healing. (10.1007/s001670100215)
  • [Case_report] A sound knowledge of the natural history of this condition allowed the treating surgeons to effectively make use of a serendipitous osteotomy, meaning that nursing care becoming easier for the patient because bony union of the fracture was virtually guaranteed. (10.1177/1758573215598498)
  • [L3] At 6 months and 1 year after initial presentation, delayed bone union was associated with resumption of throwing at maximum strength before bone union had occurred. (10.1177/0363546512443807)
  • [L3] Patients with open fractures were six times more likely to progress to non-union. (10.1177/17585732211044443)
  • [L3] Treatment of a fracture and increased operative time were risk factors for all patients, while outpatient status was protective. (10.1186/s13018-024-05214-9)

See Also

References

[1] Chapter 44 Knee Trauma. 2020.

[2] Humeral shaft fractures. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2017.10.028

[3] Open reduction and internal fixation of coronal fractures of the capitellum in patients older than 65 years. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.12.004

[4] Compartment syndrome in the forearm following fractures of the radial head or neck in children.. The Journal of Bone & Joint Surgery. 1995. DOI: 10.2106/00004623-199507000-00014

[5] Periprosthetic Fractures around the Shoulder. Shoulder & Elbow. 2012. DOI: 10.1111/j.1758-5740.2011.00147.x

[6] Open Fractures: Evaluation and Management. Journal of the American Academy of Orthopaedic Surgeons. 2003. DOI: 10.5435/00124635-200305000-00008

[7] Stress Fracture of the Radius Diaphysis in a Skeletally Immature Wrestler. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.01.040

[8] Prospective study on functional outcome of distal femur fracture treated by open reduction and internal fixation using distal femur locking plate in Tibebe Ghion Specialized Hospital, Bahirdar, North West Ethiopia. Journal of Orthopaedic Surgery and Research. 2024. DOI: 10.1186/s13018-024-05054-7

[9] Retrospective analysis of 514 cases of tibial plateau fractures based on morphology and injury mechanism. Journal of Orthopaedic Surgery and Research. 2019. DOI: 10.1186/s13018-019-1321-8

[10] The treatment of anteromedial coronoid facet fractures: a systematic review. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2020.09.008

[11] Long-Term Outcomes of Isolated Stable Radial Head Fractures. Journal of Bone and Joint Surgery. 2014. DOI: 10.2106/jbjs.m.01354

[12] Partial Avulsion Patterns in the Pediatric Humeral Medial Epicondyle. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465241310407

[13] Deep learning for automated hip fracture detection and classification. The Bone & Joint Journal. 2025. DOI: 10.1302/0301-620x.107b2.bjj-2024-0791.r1

[14] The challenge of Monteggia-like lesions of the elbow. The Bone & Joint Journal. 2018. DOI: 10.1302/0301-620x.100b2.bjj-2017-0398.r2

[15] Preoperative Comorbidities Associated With Early Mortality in Hip Fracture Patients: A Multicenter Study. Journal of the American Academy of Orthopaedic Surgeons. 2023. DOI: 10.5435/jaaos-d-21-01055

[16] Evaluation and Management of Pediatric Humeral Shaft Fractures. Journal of the American Academy of Orthopaedic Surgeons. 2022. DOI: 10.5435/jaaos-d-22-00443

[17] Delayed fixation of neglected acetabular fractures: clinical challenges and mid-term outcomes of a prospective case series. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06298-7

[18] Trends in fracture development of the upper extremity in Germany—a population-based description of the past 15 years. Journal of Orthopaedic Surgery and Research. 2020. DOI: 10.1186/s13018-020-1580-4

[19] Diagnostic accuracy of 2- and 3-dimensional imaging and modeling of distal humerus fractures. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2012.01.009

[20] Chapter 26 Distal Humerus Fracture. 2021.

[21] Anterior fracture-dislocation of the proximal interphalangeal joint. A case report.. The Journal of Bone & Joint Surgery. 1979. DOI: 10.2106/00004623-197961050-00025

[22] Surgical outcomes for post-traumatic stiffness after elbow fracture: comparison between open and arthroscopic procedures for intra- and extra-articular elbow fractures. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2019.06.008

[23] Randomized controlled trials investigating proximal humerus fractures lack consensus in inclusion criteria. JSES Reviews, Reports, and Techniques. 2025. DOI: 10.1016/j.xrrt.2025.07.023

[24] Surgical Treatment Strategy for Distal Humerus Intra-articular Fractures. Clinics in Shoulder and Elbow. 2019. DOI: 10.5397/cise.2019.22.2.113

[25] Reliability and validity of the Wrightington classification of elbow fracture-dislocation. The Bone & Joint Journal. 2020. DOI: 10.1302/0301-620x.102b8.bjj-2020-0013.r1

[26] Nonunion of a first rib fracture causing thoracic outlet syndrome in a basketball player: A case report. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2010.03.011

[27] Minimally invasive techniques utilizing the “Joy Stick” method for managing irreducible flexion-type supracondylar fractures of the humerus in older children. Journal of Orthopaedic Surgery and Research. 2024. DOI: 10.1186/s13018-024-04922-6

[28] The Impact of Surgical Timing on Mortality and Reoperation Rates in Periprosthetic Proximal Femoral Fractures: A Matched Multicenter Cohort Study. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.07.009

[29] Risk Factors for Intraoperative Periprosthetic Femoral Fractures During Primary Total Hip Arthroplasty. An Analysis From the National Joint Registry for England and Wales and the Isle of Man. The Journal of Arthroplasty. 2019. DOI: 10.1016/j.arth.2019.06.062

[30] Jones fractures in elite athletes—2025 international foot and ankle sports consensus and systematic review. Knee Surgery, Sports Traumatology, Arthroscopy. 2025. DOI: 10.1002/ksa.70241

[31] The Effects of Surgical Fracture Fixation on the Systemic Inflammatory Response to Major Trauma. Journal of the American Academy of Orthopaedic Surgeons. 2005. DOI: 10.5435/00124635-200503000-00002

[32] Isolated avulsion fracture of the lesser tuberosity of the humerus in an adolescent amateur boxer. JSES International. 2020. DOI: 10.1016/j.jseint.2020.04.010

[33] Chapter 91 Fractures of the Humeral Shaft and the Distal Humerus. 2019.

[34] Distal biceps short head tears: repair, reconstruction, and systematic review. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.04.038

[35] Management of Complex Elbow Dislocations. Journal of the American Academy of Orthopaedic Surgeons. 2015. DOI: 10.5435/jaaos-d-14-00023

[36] Current concepts in elbow fracture dislocation. Shoulder & Elbow. 2019. DOI: 10.1177/1758573219884010

[37] Classification of Olecranon Stress Fractures in Baseball Players. The American Journal of Sports Medicine. 2014. DOI: 10.1177/0363546514528099

[38] Treatment of chronically dislocated elbows: A report of three cases. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.09.003

[39] Presentation and Surgical Management of Multiple Ligament Knee Injuries. Journal of Bone and Joint Surgery. 2023. DOI: 10.2106/jbjs.20.02051

[40] Classification of Olecranon Stress Fractures in Baseball Players: Letter to the Editor. The American Journal of Sports Medicine. 2014. DOI: 10.1177/0363546514541043

[41] Chapter 27 Fractures of the Proximal Radius and Ulna and Dislocations of the Elbow. 2021.

[42] Overhead arm positioning in the rehabilitation of elbow dislocations: An in vitro biomechanical study. Journal of Hand Therapy. 2022. DOI: 10.1016/j.jht.2022.01.008

[43] Orthopaedic Aspects of All-terrain Vehicle-related Injury. American Academy of Orthopaedic Surgeon. 2011. DOI: 10.5435/00124635-201104000-00006

[44] Distal triceps tendon rupture and repair in an otherwise healthy pediatric patient: A case report and review of the literature. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.06.002

[45] Factors Influencing Infection Rates After Open Fractures of the Radius and/or Ulna. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.02.008

[46] Correlation of Throwing Mechanics With Elbow Valgus Load in Adult Baseball Pitchers. The American Journal of Sports Medicine. 2009. DOI: 10.1177/0363546509336721

[47] Acute proximal humeral fractures in adults. Journal of Hand Therapy. 2017. DOI: 10.1016/j.jht.2017.05.005

[48] THE CLASSIC: Displaced Proximal Humeral Fractures. Clinical Orthopaedics & Related Research. 2006. DOI: 10.1097/01.blo.0000198718.91223.ca

[49] Revision Ulnar Collateral Ligament Reconstruction Using a Suspension Button Fixation Technique. The American Journal of Sports Medicine. 2009. DOI: 10.1177/0363546509350109

[50] Increased Medial Elbow Torque Is Associated With Ball Velocity Rather Than a History of Medial Elbow Injuries in Youth Baseball Pitchers. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.07.016

[52] Editorial Commentary : The Limitations of Elbow Valgus Torque as an Injury Predictor. Arthroscopy. 2026. DOI: 10.1002/arj.70098

[53] The Evolution and Interpretation of the Gustilo and Anderson Classification. Journal of Bone and Joint Surgery. 2018. DOI: 10.2106/jbjs.18.00342

[54] The effect of excision of the radial head and metallic radial head replacement on the tension in the interosseous membrane. The Bone & Joint Journal. 2013. DOI: 10.1302/0301-620x.95b10.31844

[56] Intramedullary nail versus sliding hip screw for stable and unstable trochanteric and subtrochanteric fractures. The Bone & Joint Journal. 2022. DOI: 10.1302/0301-620x.104b2.bjj-2021-1078.r1

[57] Combined posterolateral and posteromedial rotatory instability of the elbow. Injury Extra. 2007. DOI: 10.1016/j.injury.2007.01.039

[59] Complex instability of the elbow. Injury. 2017. DOI: 10.1016/j.injury.2013.09.032

[60] The long-term outcome of childhood supracondylar humeral fractures. The Bone & Joint Journal. 2016. DOI: 10.1302/0301-620x.98b10.35923

[62] Displaced Femoral Neck Fractures in Workers’ Compensation Patients Aged 45-65 Years: Is It Best to Fix the Fracture or Replace the Joint?. The Journal of Arthroplasty. 2020. DOI: 10.1016/j.arth.2020.06.003

[64] Open reduction internal fixation of acromion fracture with open rotator cuff repair: a case report. JSES International. 2020. DOI: 10.1016/j.jseint.2020.03.004

[65] Capitellar Fractures in Children and Adolescents. Journal of Bone and Joint Surgery. 2017. DOI: 10.2106/jbjs.16.01393

[66] Proximal humerus fractures: epidemiology and trends in surgical management of hospital-admitted patients in Portugal. JSES International. 2022. DOI: 10.1016/j.jseint.2021.12.003

[68] Musculoskeletal Injuries in Iraq and Afghanistan. Journal of the American Academy of Orthopaedic Surgeons. 2016. DOI: 10.5435/jaaos-d-15-00123

[69] Treatment of Fractures of the Fingers. What’s New?. Journal of Hand Surgery. 2003. DOI: 10.1054/jhsb.2002.0889

[70] Non-Union of Radial Neck Fracture: A Case Report and Review of Literature. Shoulder & Elbow. 2010. DOI: 10.1111/j.1758-5740.2010.00080.x

[71] Supracondylar ostectomy and shortening (S.O.S.) for distal humerus nonunions. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2024.05.004

[72] Epidemiology and Treatment of Olecranon Fractures: a nationwide register-based analysis of 27,880 cases in Denmark from 1999 to 2018. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05970-2

[73] Factors influencing time to return to sport following clavicular fractures in adolescent athletes. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2021.04.006

[74] Complications and functional outcomes after transolecranon distal humerus fracture. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2020.07.012

[75] Management of Complications of Forearm Fractures. Hand Clinics. 2015. DOI: 10.1016/j.hcl.2015.01.010

[76] Fracture of the supracondylar process of the humerus in an adolescent athlete. JSES International. 2020. DOI: 10.1016/j.jseint.2020.07.011

[77] Regarding “Acute traumatic brachialis rupture in a young rugby player: a case report” and “Acute brachialis muscle rupture caused by closed elbow dislocation in a professional American football player”. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2013.01.016

[79] Pelvic and Acetabular Fractures.. The Journal of Bone & Joint Surgery. 1986. DOI: 10.2106/00004623-198668080-00035

[80] Treatment of Mason Type II Radial Head Fractures Without Associated Fractures or Elbow Dislocation: A Systematic Review. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.03.042

[81] Displacement of diaphyseal clavicle fractures related to patient position and progressive displacement in the peri-injury period. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2018.01.004

[83] Simple dislocations of the elbow: evaluation and treatment. Hand Clinics. 2004. DOI: 10.1016/j.hcl.2004.07.002

[84] Case report of a proximal humeral fracture with an avulsion fracture of the lesser tuberosity in an adolescent girl. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.05.054

[85] Complex Elbow Instability. Journal of the American Academy of Orthopaedic Surgeons. 2006. DOI: 10.5435/00124635-200605000-00003

[86] Treatment of olecranon fractures in older individuals: a cross-sectional survey of surgeon treatment preferences. JSES International. 2024. DOI: 10.1016/j.jseint.2023.10.009

[87] Are bone bruises a possible cause of osteochondritis dissecans of the capitellum? a case report and review of the literature. Archives of Orthopaedic and Trauma Surgery. 2005. DOI: 10.1007/s00402-005-0018-0

[88] Superior versus anteroinferior plating for displaced midshaft clavicle fractures: a systematic review and meta-analysis of union, function, and complications. Clinics in Shoulder and Elbow. 2026. DOI: 10.5397/cise.2025.01179

[89] The impact of upper-extremity injuries on polytrauma patients at a level 1 trauma center. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2021.10.005

[90] Acute Transverse Patellar Fracture Associated with Weightlifting. The American Journal of Sports Medicine. 2001. DOI: 10.1177/03635465010290021901

[91] Megaprosthetic replacement in complex distal humerus fractures in elderly patients: a case series. Journal of Orthopaedic Surgery and Research. 2024. DOI: 10.1186/s13018-023-04465-2

[92] Triceps tendon avulsions in children and young adult patients: a commonly delayed diagnosis. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.02.031

[93] Non-operatively Treated Fractures of the Anteromedial Facet of the Coronoid Process: A Report of Six Cases. Shoulder & Elbow. 2010. DOI: 10.1111/j.1758-5740.2009.00044.x

[94] Radiological Identification of Injury to the Kaplan Fibers of the Iliotibial Band in Association With Anterior Cruciate Ligament Injury. The American Journal of Sports Medicine. 2020. DOI: 10.1177/0363546520931854

[95] Reliability of the CURL classification for proximal ulna fracture-dislocations of the elbow. JSES International. 2024. DOI: 10.1016/j.jseint.2023.11.008

[96] Pectoralis Major Avulsion in a Skeletally Immature Wrestler. The American Journal of Sports Medicine. 2010. DOI: 10.1177/0363546509351559

[97] Fracture of the atlantal arch causing atlanto-axial instability. Report of a case.. The Journal of Bone & Joint Surgery. 1986. DOI: 10.2106/00004623-198668080-00024

[98] Incidence and quality of care for open fractures in England between 2008 and 2019. The Bone & Joint Journal. 2022. DOI: 10.1302/0301-620x.104b6.bjj-2021-1097.r2

[99] The degree of articular depression as a predictor of soft‐tissue injuries in tibial plateau fracture. Knee Surgery, Sports Traumatology, Arthroscopy. 2012. DOI: 10.1007/s00167-012-2201-5

[100] Reliability and Validity of the Wrightington Classification of Elbow Fracture Dislocation. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2021.03.099

[101] Radiographic evaluation of partial articular radial head fractures: assessment of reliability. JSES International. 2021. DOI: 10.1016/j.jseint.2021.04.012

[102] Diagnostic accuracy of 2- and 3-dimensional computed tomography and solid modeling of coronoid fractures. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2013.02.009

[103] Stress fracture of the ulna in a professional tennis player using a double‐handed backhand stroke. Knee Surgery, Sports Traumatology, Arthroscopy. 2001. DOI: 10.1007/s001670100215

[104] Primum non nocere: a case of a humeral fracture in a patient with fibrodysplasia progressiva ossificans. Shoulder & Elbow. 2015. DOI: 10.1177/1758573215598498

[105] Outcome of Nonoperative Treatment for Humeral Medial Epicondylar Fragmentation Before Epiphyseal Closure in Young Baseball Players. The American Journal of Sports Medicine. 2012. DOI: 10.1177/0363546512443807

[106] Prevalence and risk factors for pseudarthrosis in humeral shaft fractures treated by minimally invasive plate osteosynthesis: A 10-year review. Shoulder & Elbow. 2021. DOI: 10.1177/17585732211044443

[107] Short-term adverse event rates and risk factors following total elbow arthroplasty for fracture and arthropathy: a matched analysis of nationally representative data. Journal of Orthopaedic Surgery and Research. 2024. DOI: 10.1186/s13018-024-05214-9

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.