 I am Dr. Bharat Kekadadi, consultant hand and upper limb surgeon, Manipal Hospital, Malaysia. So today I will be talking about elbow injuries. So after road traffic accidents, commonly after bike accidents, you might have seen the youth falling from the bike and it is called a fall on the outstretched hand when they can very commonly sustain injury to the elbows. So if you see the fall on the outstretched hand, the line of injury can be either in the wrist and then the forearm, elbow, clavicle, shoulder and then henceforth. So elbows are very important because if you want to reach something, reach any object, if you want to right, if you want to hold and lift anything, so the elbows are very important. It is a hinge joint, the elbow movements are very very crucial and even if you want to have your day to day meal like breakfast, lunch, dinner or drink a glass of water. So elbow is very important because if you do not have movements in the elbow, extremely difficult for you to do your routine activity. So if you see the elbow, the range of flexion is around 100 and 40 degrees to 0 extension, it is 180 degrees if you can call, it is straight elbow. So these injuries, the elbow injuries can be either a soft injury or a bony injuries. So bony injuries, the moment the patient come, we do an x-ray, there will be some swelling, tenderness, achy mouses, edema. So depending on the nature of the pain, depending on the severity of the injury, we initially advise what you call a basic x-rays where you can be able to see injury to the fracture of the lateral condyle, fracture of the middle condyle or even the fracture in the distal humorous intercontal region or there could be fracture of the olechronome or there could be fracture of the radial head. On the other side, we have a patient where the x-ray is normal but they still have pain and instability. That means they are not able to hold an object and lift, they are not able to do their movements. So these are the patients, you must suspect soft tissue injuries because elbow, the only stability in the elbow is the soft tissue. You can see the lateral side, you have the lateral collateral ligament, it is got its own complex, the lateral ulnar collateral and the lateral radial collateral ligament. On the middle side, you have the middle collateral ligament which attach from the middle of the upper condyle to the coronet process and which has got three bundles, anterior fracture and the oblique bundle, it is very important. And then you have the muscles, the brachialis muscle and the biceps from the anteriorly along with the capsule and posteriorly you have the triceps muscle which is responsible for elbow extension. So once you diagnose instability in elbow injuries, you always subject them to a MRI scan. So with that you will be able to show us which is the injury, the middle collateral, lateral collateral injuries. And many of these patients in purely soft tissue injuries, they get misted for or neglected for 2 months, 3 months, they do not realize that they have a problem, then they come back after 2 months, 3 months and then we do a scan, then see it is unstable and the ligaments are injured. So both the soft tissue as well as the bone injuries are ideally treated at the best at the same time. A stable elbow undisclosed fracture which we treat with a plaster or a cast for 3 to 4 weeks and then start physiotherapy. A stable elbow or a displaced fracture, we always do a X-ray and then if required we do a CT scan to see the personality of the fracture, study the fracture. Elbow being the fracture around the elbow being a intraticular, so it is important to reduce the fracture as well and fix them. We got a very good quality implants nowadays to fix the elbow fractures, the lateral condyle, the middle condyle, the olerocone fracture, the radial head fracture, they can fix to the plate and screw. So once if you fix them with good stability and restore the articular congerality, we can mobilize them as early as possible, say 48 to 72 hours we can mobilize and get back the full range of movements. The problem in the elbow is we have to remember that it is prone for stiffness. There is something called myositis ossificans where a new bone formation can happen in the elbow which lead to stiffness. I happened to treat a lady recently who had a 3-year-old injury with a right hand elbow which is straight, not able to flex, not able to eat a daily food. Somebody has to help her to have a daily meal. So this patient completely bone growth all around myositis ossificans, the bridging of the bone, it is anchored. Fortunately, the joint is intact, so we are able to operate the patient release, it is called a global release, over the top approach, we are releasing the capsule, then we are releasing the bony bone formation all around the joint and also with the lateral approach, bone formation all around the joint, then we are able to get a good moment and today she is after one month of surgery, she is able to have her own meals with her own hand. So it is so crucial that elbow because elbow injuries are prone for stiffness, they are going for stiffness. So that is very crucial that you avoid stiffness, you start early mobilization, early physiotherapy and get back the full range of movements to do daily routine activities.