Hume fracture
Encyclopedia
The Hume fracture is an injury of the elbow
comprising a fracture
of the olecranon
with an associated anterior dislocation of the radial head
which occurs in children
. It was originally described as an undisplaced olecranon fracture, but more recently includes displaced fractures and can be considered a variant of the Monteggia fracture
.
The injury was described in 1957 by A.C. Hume of the orthopaedic surgery
department of St Bartholomew's Hospital, Rochester.
of the elbow
leading to fracture of the olecranon, with pronation
of the forearm
leading to the radial head dislocation.
by supination
of the forearm. This was followed by immobilisation of the arm in a plaster cast
with the elbow flexed
at 90° and the forearm in supination for 6 weeks.
Where the olecranon fracture is displaced, open reduction internal fixation is recommended. Once the olecranon has been repaired, closed reduction of the radial head dislocation is usually possible. This is followed by immobilisation with the elbow flexed to 90° and the forearm in the neutral position. The duration of immobilisation depends on clinical assessment of the joint, and mobilisation may be possible after as little as 4 weeks.
Elbow
The human elbow is the region surrounding the elbow-joint—the ginglymus or hinge joint in the middle of the arm. Three bones form the elbow joint: the humerus of the upper arm, and the paired radius and ulna of the forearm....
comprising a fracture
Bone fracture
A bone fracture is a medical condition in which there is a break in the continuity of the bone...
of the olecranon
Olecranon
The olecranon is a large, thick, curved bony eminence of the forearm that projects behind the elbow.It is situated at the upper end of the ulna, one of the two bones in the forearm...
with an associated anterior dislocation of the radial head
Head of radius
The head of the radius has a cylindrical form, and on its upper surface is a shallow cup or fovea for articulation with the capitulum of the humerus....
which occurs in children
Child
Biologically, a child is generally a human between the stages of birth and puberty. Some vernacular definitions of a child include the fetus, as being an unborn child. The legal definition of "child" generally refers to a minor, otherwise known as a person younger than the age of majority...
. It was originally described as an undisplaced olecranon fracture, but more recently includes displaced fractures and can be considered a variant of the Monteggia fracture
Monteggia fracture
The Monteggia fracture is a fracture of the ulna that affects the joint with the radius. More precisely, it is a fracture of the proximal third of the ulna with dislocation of the head of the radius...
.
The injury was described in 1957 by A.C. Hume of the orthopaedic surgery
Orthopedic surgery
Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system...
department of St Bartholomew's Hospital, Rochester.
Mechanism of injury
Although the precise mechanism of injury is unclear, the injury occurs in children who have fallen heavily with their arm trapped under the body. In his original description of the injury, Hume suggested that the injury occurred as a result of hyperextensionExtension (kinesiology)
In kinesiology, extension is a movement of a joint that results in increased angle between two bones or body surfaces at a joint. Extension usually results in straightening of the bones or body surfaces involved. For example, extension is produced by extending the flexed elbow. Straightening of...
of the elbow
Elbow
The human elbow is the region surrounding the elbow-joint—the ginglymus or hinge joint in the middle of the arm. Three bones form the elbow joint: the humerus of the upper arm, and the paired radius and ulna of the forearm....
leading to fracture of the olecranon, with pronation
Pronation
In anatomy, pronation is a rotational movement of the forearm at the radioulnar joint, or of the foot at the subtalar and talocalcaneonavicular joints. For the forearm, when standing in the anatomical position, pronation will move the palm of the hand from an anterior-facing position to a...
of the forearm
Forearm
-See also:*Forearm flexors*Forearm muscles...
leading to the radial head dislocation.
Management
In the original description by Hume, where the olecranon fractures were not displaced, treatment consisted of closed reduction of the radial head dislocation under general anaesthesiaGeneral anaesthesia
General anaesthesia is a state of unconsciousness and loss of protective reflexes resulting from the administration of one or more general anaesthetic agents...
by supination
Supination
Supination is a position of either the forearm or foot; in the forearm when the palm faces anteriorly, or faces up . Supination in the foot occurs when a person appears "bow-legged" with their weight supported primarily on the anterior of their feet.The hand is supine in the anatomical position...
of the forearm. This was followed by immobilisation of the arm in a plaster cast
Orthopedic cast
An orthopedic cast, body cast or surgical cast, is a shell, frequently made from plaster, encasing a limb to hold a broken bone in place until healing is confirmed...
with the elbow flexed
Flexion
In anatomy, flexion is a position that is made possible by the joint angle decreasing. The skeletal and muscular systems work together to move the joint into a "flexed" position. For example the elbow is flexed when the hand is brought closer to the shoulder...
at 90° and the forearm in supination for 6 weeks.
Where the olecranon fracture is displaced, open reduction internal fixation is recommended. Once the olecranon has been repaired, closed reduction of the radial head dislocation is usually possible. This is followed by immobilisation with the elbow flexed to 90° and the forearm in the neutral position. The duration of immobilisation depends on clinical assessment of the joint, and mobilisation may be possible after as little as 4 weeks.