Elbow fracture (peds): Difference between revisions
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== | ==Supracondylar Fracture== | ||
* 7% have nerve injury (median & radial most common) | * 7% have nerve injury (median & radial most common) | ||
* Can get ischemia due to brachial artery compression from increased compartment pressure | * Can get ischemia due to brachial artery compression from increased compartment pressure | ||
===Diagnosis=== | |||
* Anterior humeral line does NOT intersect middle third of capitellum | * Anterior humeral line does NOT intersect middle third of capitellum | ||
* Small anterior fat pad sometimes normal, posterior fat pad always abnormal | * Small anterior fat pad sometimes normal, posterior fat pad always abnormal | ||
===Classificiation=== | |||
* Type I - Nondisplaced | * Type I - Nondisplaced | ||
* Type II - Displaced w/ intact posterior cortex | * Type II - Displaced w/ intact posterior cortex | ||
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*On XR look @ development of secondary ossification centers (must occur in following order, age not as important, ie if see ossification of trochlea you MUST also see CRI as well!) | *On XR look @ development of secondary ossification centers (must occur in following order, age not as important, ie if see ossification of trochlea you MUST also see CRI as well!) | ||
===Treatment=== | |||
Treatment | |||
* Type I | * Type I | ||
* Immobilize using a posterior splint and sling (extend from wrist to axilla) | ** Immobilize using a posterior splint and sling (extend from wrist to axilla) | ||
* Refer to ortho within 1 week | ** Refer to ortho within 1 week | ||
* Type II & III | * Type II & III | ||
* Orthopedic consultation regarding closed versus open reduction w/ percutaneous pinning | ** Orthopedic consultation regarding closed versus open reduction w/ percutaneous pinning | ||
* Admit | ** Admit | ||
==Lateral Condylar Fracture== | |||
===Diagnosis=== | |||
* Radiocapitellar line does NOT intersect the middle of the capitelum in all views | * Radiocapitellar line does NOT intersect the middle of the capitelum in all views | ||
* May be only sign if fracture is entirely through the growth plate | * May be only sign if fracture is entirely through the growth plate | ||
* Fat Pad Sign | * Fat Pad Sign | ||
* May be only sign of nondisplaced fx | * May be only sign of nondisplaced fx | ||
==Medial Epicondylar Fractures== | |||
===Diagnosis=== | |||
* Displacement of medial epicondyle ossification center | * Displacement of medial epicondyle ossification center | ||
* May become entrapped w/in elbow joint | * May become entrapped w/in elbow joint | ||
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* (Medial epicondyle normally ossifies before the trochlea) | * (Medial epicondyle normally ossifies before the trochlea) | ||
* Fat pad sign not usually present because most injuries are extra-articular | * Fat pad sign not usually present because most injuries are extra-articular | ||
==See Also== | ==See Also== | ||
Ortho: Elbow Fracture | Ortho: Elbow Fracture | ||
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Rads: Elbow Xray Peds | Rads: Elbow Xray Peds | ||
==Source== | |||
UpToDate | |||
[[Category:Peds]] | [[Category:Peds]] | ||
Revision as of 06:41, 6 June 2011
Supracondylar Fracture
- 7% have nerve injury (median & radial most common)
- Can get ischemia due to brachial artery compression from increased compartment pressure
Diagnosis
- Anterior humeral line does NOT intersect middle third of capitellum
- Small anterior fat pad sometimes normal, posterior fat pad always abnormal
Classificiation
- Type I - Nondisplaced
- Type II - Displaced w/ intact posterior cortex
- Type III - no cortical contact
- On XR look @ development of secondary ossification centers (must occur in following order, age not as important, ie if see ossification of trochlea you MUST also see CRI as well!)
Treatment
- Type I
- Immobilize using a posterior splint and sling (extend from wrist to axilla)
- Refer to ortho within 1 week
- Type II & III
- Orthopedic consultation regarding closed versus open reduction w/ percutaneous pinning
- Admit
Lateral Condylar Fracture
Diagnosis
- Radiocapitellar line does NOT intersect the middle of the capitelum in all views
- May be only sign if fracture is entirely through the growth plate
- Fat Pad Sign
- May be only sign of nondisplaced fx
Medial Epicondylar Fractures
Diagnosis
- Displacement of medial epicondyle ossification center
- May become entrapped w/in elbow joint
- Use CRITOE to determine if bone in joint is medial epicondyle vs. normal trochlear oss center
- If think is trochlear but cannot see medial epicondyle, fragment is medial epicondyle
- (Medial epicondyle normally ossifies before the trochlea)
- Fat pad sign not usually present because most injuries are extra-articular
See Also
Ortho: Elbow Fracture
Ortho: Elbow (Minor)
Peds: Supracondylar
Rads: Elbow Xray Peds
Source
UpToDate