WordPress.com



Elbow FracturesPaediatric elbow2438400-5880100 Appears ClosesC apitellum 1-3yrs 14yrsR adial head 3-4yrs 16yrs I nt epicondyle 5-6yrs 15yrsT rochlea 7-9yrs 14yrsO lecranon 9-10yrs 14yrsL at epicondyle 11-12yrs 16yrsFat pads: anterior displacement in 50% radial head/neck #’s; if posterior present, # in >95%XR interpretation:1. Ant humeral line should bisect capitellum in middle 1/3 on lateral; abnormal in supracondylar #, lat condyle2. Angle between line through centre of capitellum and ant humeral line should be 30-45deg3. Radio-capitellar line: line drawn through centre of radial shaft should transect radial head and capitellum; abnormal in lat condyle, radial neck, Monteggia, elbow dislocation4. Baumann angle: angle between physeal line of lat condyle of humerus and line perpendicular to long axis of humeral shaft = 8-28degs; decr angle varus deformity; abnormal in supracondylar #5. Bowing of anterior fat pad6. Any posterior fat pad0 Appears ClosesC apitellum 1-3yrs 14yrsR adial head 3-4yrs 16yrs I nt epicondyle 5-6yrs 15yrsT rochlea 7-9yrs 14yrsO lecranon 9-10yrs 14yrsL at epicondyle 11-12yrs 16yrsFat pads: anterior displacement in 50% radial head/neck #’s; if posterior present, # in >95%XR interpretation:1. Ant humeral line should bisect capitellum in middle 1/3 on lateral; abnormal in supracondylar #, lat condyle2. Angle between line through centre of capitellum and ant humeral line should be 30-45deg3. Radio-capitellar line: line drawn through centre of radial shaft should transect radial head and capitellum; abnormal in lat condyle, radial neck, Monteggia, elbow dislocation4. Baumann angle: angle between physeal line of lat condyle of humerus and line perpendicular to long axis of humeral shaft = 8-28degs; decr angle varus deformity; abnormal in supracondylar #5. Bowing of anterior fat pad6. Any posterior fat padSupra-condylar fracture humerusMEDIAN NBRACHIAL A2336800-1711960Epidemiology: peak incidence 5-8yrs; most common paeds elbow fracture; most common # <8yrs; > 95% FOOSH (flexion type, <5%, from fall on flexed elbow, rare, will have volar displacement)Pathology: distal fragment displaced posteriorly; significantly displaced # are surgical emergency (brachial art, median / radial / ulnar nerve at risk; nerve involvement in 6-16% Volkmann’s ischaemic contracture); risk of cmptmt syndrome00Epidemiology: peak incidence 5-8yrs; most common paeds elbow fracture; most common # <8yrs; > 95% FOOSH (flexion type, <5%, from fall on flexed elbow, rare, will have volar displacement)Pathology: distal fragment displaced posteriorly; significantly displaced # are surgical emergency (brachial art, median / radial / ulnar nerve at risk; nerve involvement in 6-16% Volkmann’s ischaemic contracture); risk of cmptmt syndromeGartland classification: # in distal 1/3 of humerusType I: undisplaced # with evidence of jt effusion; ant and post periosteum intact; prognosis goodType II: displaced (usually posteriorly), but intact post periosteum; # visible anteriorly, hinging posteriorly; prognosis good IIb: as above + rotation; prognosis bad, need OTType III: displaced ant and post periosteum; no continuity between shaft and distal humerus; can displace postmed, postlat, antlat; prognosis bad, need OTMng: urgent ortho review if NV compromise; immediate ED reduction if cool / pale hand; ortho review if no pulse, but hand otherwise OK; to manipulate – traction at 20deg flexion flexion as far as possible while still retaining radial pulse Type I: wrist-shoulder backslab with elbow flexed 90deg for 4/52; OT preferred in adults as stiffness common, but otherwise not generally recommended; ortho FU within 48hrs Type II and III: need closed / open reduction by ortho Indications for reduction / manipulation: evidence of NV compromise / <50% bony apposition / dorsal angulation >15 deg / lat or medial tilt >10 deg / any rotational deformity / any varus or valgus deformity / compoundComplications: radial (postmed) / median (postlat, esp ant interosseous nerve which is motor only) / ulnar (less common) nerve (7%), Volkmann ischaemic contracture, compartment syndrome, non / malunion, myositic ossificans; absence of radial pulse initially in children is usually due to vasospasmIntercondylar # of humerusMore common in adults; classifiied as T / Y / H depending on segments; assoc with severe ST injEpicondylar fractures of humerusULNAR N Medial epicondyle (appears at 5-6yrs): 3rd most common paeds elbow #; most common 9-14yrs; 50% assoc with elbow dislocation; risk of medial epicondyle becoming trapped in jt, esp in spontaenously reduced elbow dislocation; needs OT if >1cm of articular surface, or ulnar nerve involvement; needs ortho reviewLateral condyle (appears at 11-12yrs): tend to be unstable; often also involves all of capitellum and ? of trochlea; due to varus stress on extended arm in supination; Milch I = Salter Harris IV; Milch II = Salter Harris II (into jt and lat part of trochlea), most common; OT if displaced, often required; ulnar nerve involvement; needs ortho reviewElbow dislocation ULNAR NBRACHIAL A1422400-84582090% postero-lateral; 85% have good functional outcome; 3rd most common large jt dislocationMOI: hyperextension, abduction; incomplete ant and post ligamentous components ruptured; complete ant, post and medial collateral lig ruptured090% postero-lateral; 85% have good functional outcome; 3rd most common large jt dislocationMOI: hyperextension, abduction; incomplete ant and post ligamentous components ruptured; complete ant, post and medial collateral lig rupturedComplications: 1/3 have # (eg. Coronoid process, radial head); 15% have medial epicondyle # (may become entrapped post-reduction, esp in children); 5-13% have NVI; 8% have brachial artery inj; 15% ulnar nerve inj (usually resolves with conservative trt); radial and median nerve inj also occur; “terrible triad” = dislcoation + radial head and coronoid #Mng: reduce with traction, correction of medial / lateral displacement, downward p on forearm and flexion with thumbs pushing on olecranon; may fail if radial head #; backslab in 90deg flexion and sling for 1-2/52; should have FROM post-reduction – concern if locking / clicking Re: # / capsule tear etc…Notes from: ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download