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Injuries around the elbow
This document discusses fractures around the elbow joint that commonly occur in children, including supracondylar fractures of the humerus, lateral condyle fractures of the humerus, and distal radial fractures. It provides details on the classification, epidemiology, clinical presentation, complications, and treatment options for these pediatric elbow injuries. Common fracture types are described along with approaches to nonoperative and operative management depending on the degree of displacement and integrity of the articular surface. Complications addressed include malunion, growth disturbances, and avascular necrosis.
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- 1. Prepared by: Dr. MostafaAzab Lecturer of Orthopedic Surgery Cairo University
- 2. Supracondylar Fracture ofthe Humerus Is a fracture, usually of the just abovehumerusdistal the , although it mayepicondyles occur elsewhere. While relatively rare in adults it is one of the most common fractures to occur in children and is often associated with the development of serious complications.
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- 4. TYPES: There are threetypes based on the degree of separationof the fractured fragments: 1-Type I: undisplaced or minimally displaced fractures. 2-Type II: partially displaced. 3-Type III: fully displaced.
- 5. Epidemiology 1-This is themost common elbow fracture in children. 2-About 60% of fractures in children. 3-It is most common in children <10. 4- Peak incidence is between the ages of 5-8 years of age. 5-Primarily in children who are around age 7 years.
- 6. Presentation: The child presentswith history of a falling on an outstretched hand . Followed by pain, swelling and inability to move the affected elbow. On examination: Unusual prominence of olecranon process but because it is a supracondylar fracture, the three bony point relationship is maintained, as in a normal elbow.
- 7. Complications: 1- Brachial ArteryInjury 2- Nerve Injuries 3-Volkmann’s Ischaemic contracture 4-Myositis ossificans 5-Mal-union(Cubitus Varus)
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- 11. Lateral Humeral CondyleFractures Lateral condyle fractures are common and their outcomes have historically been worse than supracondylar fractures articular nature, and often, missed diagnosis lead to an unacceptably high incidence of malunion and nonunion.
- 12. Epidemiology & Types: 6Years old is the commonest age
- 13. Classification: Type I: SHType IV TypeII: SH TypeII
- 14. According to Displacement: Classificationbased on fracture displacement: Type 1: displacement <2mm, indicating intact cartilaginous hinge Type 2: displacement 2- 4mm, displaced joint surface Type 3: displacement >4mm, joint displaced and rotated
- 15. Diagnosis: Physical exam: Exam maylack the obvious deformity often seen with supracondylar fractures. Swelling and tenderness are usually limited to the lateral side. Imaging: Radiographs: If the lateral condyle and capitellum have not ossified then radiographic findings can be subtle. Contra-lateral radiographs are very important. MRI and arthrograms can be helpful as well best judge if intra-articular incongruity.
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- 17. Treatment Nonoperative long arm casting: Indications: Only indicated if < 2 mm of displacement, which indicates the cartilaginous hinge is most likely intact. Technique follow patient very closely (every 4-5 days) Operative CRPP: Indications: closed reduction achieves adequate reduction with no evidence of intra-articular incongruity Technique. Divergent pin configuration most stable open reduction and percutaneous pinning Indications: if > 2mm of displacement any joint incongruity Technique: Kocher lateral approach used avoid dissection of posterior aspect of lateral condyle (source of vascularization) intraoperative arthrograms are valuable to delineate the fracture and ensure anatomic reduction
- 18. Complications 1-Lateral overgrowth bump 2-AVN posteriordissection can result in lateral condyle osteonecrosis 3-Nonunion/malunion : caused from delay in diagnosis and improper treatment may result in cubitus valgus and tardy ulnar nerve palsy
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- 20. Pulled Elbow(Nursemaid’s Elbow) Age: 1 to 4 yrs Elbow is pronated and flexed Painful movements
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- 22. OTHER INJURIES FREQUENCYINJURYELBOWPEDIATRIC REQUIRES ORPEAKAGE% ELBOW INJURIES FRACTURE TYPE Majority741%SUPRACONDYLA R FRACTURE Rare328%RADIAL HEAD Majority611%LATERAL CONDYLE Minority118%MEDIAL EPICONDYLE Minority105%RADIAL HEAD AND NECK # Rare135%ELBOW DISLOCATION Rare101%MEDIAL CONDYLE #
- 23. Distal Radial Injuries InAdults In Children
- 24. Salter Harris Classification I– S = Slip (separated or straight across). Fracture of the cartilage of the physis (growth plate) II – A = Above. The fracture lies above the physis, or Away from the joint. III – L = Lower. The fracture is below the physis in the epiphysis. IV – T = Through. The fracture is through the metaphysis, physis, and epiphysis. V – R = Rammed (crushed). The physis has been crushed.
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- 27. Principles of Treatment AnatomicalReduction Fixation by non-threaded wires Early mobilization
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- 29. Colle’s Fracture Extra-articular fractureof the cancellous bone of the distal end of the Radius Displacement: 1-Shortening 2-Radial Deviation 3- Dorsal Angulation
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- 31. Mechanism of Injury Fallon the outstretched hand
- 32. Classification Type I: extraarticular, undisplaced Type II: extra articular, displaced Type III intra articular, undisplaced Type IV: intra articular, displaced
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