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Paediatrics FCRS > Elbow trauma > Flashcards

Elbow trauma Flashcards

Supracondylar fx Lateral epicondyle fx

1
Q

What is this?

A
  • An type 3 Garland supracondylar fx
  • fall onto outstretched hand
  • consisis of more than 1/2 of all paediatric elbow fx
  • Extension type more common 95-98%
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2
Q

what are the assoc injuires with supracondylar fx?

A
  • Anterior interosseous N neurapraxia ( branch median n)
    • most common nerve palsy seen w SC fx
    • weakness FDP index, FPL thumb- can’t make ok sign, weak FDP middle & pronator quadratus
  • Radial N palsy
    • 2nd common neurapraxia
  • Ulna N palsy
    • seen w flexion type SC- hand instrinsic weakness
  • nearly all types of neurapraxia assoc with SC resolve spontaneously, so further dx studies not required
  • Vascular injury 1%
    • Rich collateral circulation can maintain despite vascular injury
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3
Q

Describe the age of ossification of the elbow epiphysis?

A
  • Capitellum 1yr
  • Radial head 4 yrs
  • Internal (medial) epicondyle 6yrs
  • Trochlear 8 yrs
  • Olecranon 10 years
  • Lateral Epicondyle 12 yr

** CRITOL**

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4
Q

Describe the classification of elbow fx?

A
  • Gartland
  • Extension or Flexion type
  • Type 1
    • non displaced
  • Type 2
    • displaced, posterior cortex intact- see pic
  • Type 3
    • completely displaced- open reduction & PP
  • Type 4
    • complete periosteal disruption with instability in flexion/extension
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5
Q

what are the signs of supracondylar fx?

A
  • AIN neurapraxia
    • unable to flex IPJ of thumb and DIPJ of index finger - OK sign
  • Radial n palsy
    • inability to extend wrist or digits
  • Vascular status
    • at presentation 5-17%
    • defined as cold, pale & pulseless hand
    • a warm pink pulseless hand does not qualify as vascular insufficiency
    • tx with immediate reduction and pinningi Theatre. attempted closed reduction in ER first
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6
Q

What are you looking for on radiographs with a SC fx?

A
  • Anterior humeral line should intersect the middle third of the capitellum
  • Capetilum moves posteriorly to this reference line in an Extension type SC fx
  • Baumann angle
    • created by a line perpendicular to humeral shaft adn a line along the lateral condylar physis as viewed on ap image
    • normal 85-89 degrees cf contralteral side
    • deviation of 5 degrees= coronal plane deformity & should not be accepted
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7
Q

What is the tx of Sc fx?

A

Non operative

  • type 1
  • type 2- ant humeral line insects capitellum, minimal swelling, no medial comminution
  • Posterior moulded splint then long arm cast at 90o or less
  • typically for 3 weeks

​Surgery

  • Closed reduction & percutanous pinning
    • _​ _most supracondylar fx
    • Lateral fragments- supinatn w hyperflexion
    • medial fragments- pronation w hyperflexion
    • 2 lateral pins usually sufficient
    • confirm stability
    • crossed pins
      • strongest to torsional stress in expt studies
      • > risk of ulnar n injury 3-8%
    • remove pins 3 weeks
  • Open reduction and percutanous pinning
    • reduction not obtained closed
    • anterior approach
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8
Q

Describe the tx of pulseless, cool hand or floating elbow from Sc fx?

A
  • Immediate closed reduction and percutaneous pinning
    • check vascular status after reduction
    • explore if pulse if lost after reduction or if pulseless, plae hand persists after reduction
    • anteriography is typically not indicated
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9
Q

Describe the complications of Sc fx?

A
  • Pin migration
    • most common complication 2%
  • Infection
    • 1%
    • superfically, oral antibiotics
  • Cubitus Valgus
    • caused by fx malunion
    • -> tardy ulnar nerve palsy
  • ​Cubitus varus
    • ​gunstock deformity
    • caused by fx malunion
    • -> fx, cosmetic issue w little functional limitation
  • ​Recurvatum
    • _​_common w non op Type 2/3 fx
  • Nerve palsy
    • usually resolves
  • Vascular injury
  • Volkmann ischaemic contracture
    • rare
    • normally result of brachial artery compression and tx utilzing elbow hyperflexion and casting then true arterial injury
    • increase in forearm compartment pressures and loss of radial pulse w elbow flexed greater than 90o
  • ​Post op stiffness
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10
Q

What is a floating elbow?

A
  • ipislateral supracondylar humerus and a forearm fracture
  • must be operated on emergency to reduce risk of compartment syndrome
  • wrist pinned first to allow fulcrum for reduction of supracondylar fx
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11
Q

Which is the last apophysis to fuse in the elbow?

A
  • Medial epicondyle
  • aged 16-19 years
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12
Q

What is this?

A
  • A Milch 2 lateral condylar fx
  • 2nd most common pediatric elbow fx
  • 6 yrs most common
  • prognosis:
    • outcomes have been historically worse than Supracondylar fx
    • articular nature, missed dx, higher risk of malunion/nonunion
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13
Q

What is the classification of lateral condyle fx?

A
  • Milch
  • Type 1
    • fracture line is lateral to trochlear groove
    • considered SH IV
  • Type 2
    • FX line INTO trochlear Groove
    • Consider SH 2 fx
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14
Q

What are the signs and symptoms of lateral condyle fx?

A
  • elbow pain
  • swelling and tenderness limited to lateral side
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15
Q

What images are useful in lat condyle fx?

A
  • Xrays
  • Ap
  • lateral
  • internal oblique view= shows max displacement & fx pattern
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16
Q

What is the for lateral condyle fx?

A

Non operative

  • if <2mm displacement
  • cartilagenous hinge intact
  • weekly FU

Surgery

  • ​Closed reduction & percutaneous pinning
    • ​w no evidence of intra-articular incongruity
    • divergent pin placed most stable
  • ​Open reduction and percutanous pinning
    • ​if >2mm displacement
    • any joint incongruity
    • direct lateral approach
    • avoid dissesction of posterior aspect of lateral condyle ( source of vascularisation)
17
Q

What are the complications from lateral condyle fx?

A
  • AVN
    • posterior dissection -> lat condyle necrosis
    • may also occur at trochlea
  • Non union/malunion
    • caused a delay in diagnosis and improper tx
    • -> cubital valgus and tardy ulna n palsy
    • if symptomatic screw fix & bone graft non union
  • ​Lateral overgrowth/prominence spurring
    • ​in up to 50% cases reagrdless of tx
    • lateral periosteal alignment will prevent this from occuring
    • prsence of spurring is correlatd with greater intial fx displacement
  • Growth arrest w /wout angular deformity
  • unsatisfactory appearance of surgical scar

Paediatrics FCRS (27 decks)

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