Injuries Around Elbow Flashcards
First to appear amongst the ossification centres about the elbow is A. Radial head B. Olecranon C. Lateral epicondyle D. Capitellum
Answer- D. Capitellum
Capitellum is the first ossification centre about the elbow to appear. It appears around 2 years of age.
Mnemonic CRITOE helpful in remembering the progression of radiographic appearance of ossification centers around the elbow in children. C- Capitellum -2yrs R- Radius head - 4yrs I- Internal(medial) epicondyle- 6yrs T- Trochlea - 8yrs O- Olecranon- 10yrs E- External(lateral) epicondyle- 12yrs
Three point relationship is reversed in all, except A. # medial epicondyle B. # lateral epicondyle C. Supracondylar # D. Posterior elbow dislocation
Answer- C. Supracondylar #
Three point Bony landmarks in elbow -
The tips of medial and lateral epicondyles and Olecranon process have a definite relationship and these form isosceles triangle with elbow in flexed position. Three point bony relationship is not disturbed in Supracondylar fracture humerus because as the fracture occurs above the level of these bony landmarks.
These also lie transversely in straight line with elbow extended.
Triangular relation of elbow is maintained in A. Fracture ulna B. Anterior dislocation of elbow C. Posterior dislocation of elbow D. Supracondylar fracture
Answer- D. Supracondylar fracture
Three point Bony relationship is maintained in fracture Supracondylar humerus.
Three point bony relationship is disturbed with increased intercondylar distance incase of fracture medial epicondyle and condyle, fracture lateral epicondyle and condyle and fracture intercondylar humerus.
Three point bony relationship is disturbed with maintained intercondylar distance incase of fracture olecranon, dislocation of elbow.
Increased intercondylar distance is seen in fracture of all except A. Olecranon B. Medial epicondyle C. Lateral epicondyle D. Lateral condyle
Answer- A. Olecranon
Intercondylar distance is increased in fractures of medial and lateral epicondyles and condyles and fracture intercondylar humerus.
Posterolateral anconeus triangle is formed by
A. Head of radius, lateral epicondyle, medial epicondyle
B. Head of radius, lateral epicondyle, Olecranon
C. Olecranon, medial epicondyle, neck of radius
D. Neck of radius, head of radius, lateral epicondyle
Answer- B. Head of radius, lateral epicondyle, olecranon
Radial head, lateral epicondyle and tip of olecranon form a triangle over the posterolateral aspect of elbow joint. This space is occupied by the anconeus muscle and so known as anconeus triangle.
All true regarding fracture lateral condyle humerus except
A. Salted Harris type IV injury
B. Most common complication of surgical treated cases is cubitus vagus deformity
C. Tardy ulnar nerve palsy occurs
D. Cubitus varus occur more commonly than valgus
E. Open reduction and internal fixation
Answer- B. Most common complication of surgically treated cases is cubitus valgus deformity
Fracture lateral condyle humerus
This is a transphyseal interarticular injury usually involving immature skeleton of children and adolescent.
Salter Harris classified all lateral condylar physeal injuries as type IV injuries but some authors have classified some lateral condylar fractures as Salter Harris type II injury.
Salter Harris type IV and type II injury fracture treatment guidelines follow those of type IV injury- open reduction and internal fixation of displaced intra-articular fractures.
Most commonly reported complication following lateral condyle fracture - Cubitus varus / lateral spur formation (pseudo-varus)
Most frequent problematic complication - Delayed union/ nonunion
Most common sequela of nonunion with displacement is the development of progressive cubitus valgus deformity.
Tardy ulnar nerve palsy is a late complication of progressive cubitus valgus deformity occurring in lateral condylar fractures.
Fracture lateral condyle of humerus is seen in age group f A. 2-3 yrs B. 3-5 yrs C. 5-15yrs D. 15-25 yrs E. 35-45 yrs
Answer-C. 5-15 yrs.
The lateral condylar (or capitellar) epiphysis begins to ossify during the first year of life and fuses with shaft at 12-16 yrs. Between these ages it may be sheared off or avulsed by forceful traction. The maximum chances of injury is between 5-15 yrs.
A 10 year old boy presenting with cubitus varus deformity and a history of trauma 3 months back on clinical examination, has preserved 3 bony point relationship of the elbow. The most probable diagnosis is
A. Old unreduced dislocation of elbow
B. Nonunion lateral condylar fracture of humerus
C. Malunited intercondylar fracture of humerus
D. Malunited supracondylar fracture of humerus
Answer- D. Malunited supracondylar fracture of humerus
Cubitus varus deformity and preservation of three point bony relation favours the diagnosis of malunited fracture supracondylar humerus.
The most common cause of Volkmann's ischemic contracture in a child is A. Intercondylar fracture of humerus B. Fracture both bone of forearm C. Fracture lateral condyle of humerus D. Supracondylar fracture of humerus
Answer- D. Supracondylar fracture of humerus.
VIC or compartment syndrome - it is the ischemic paralysis and contracture of the muscle of forearm and hand and less frequently of the leg.
Etiopathogenesis- increased pressure in closed fascial space causes muscle ischemia, further increasing pressure, decreasing blood flow and lead to muscle necrosis, fibrosis.
Although compartmental syndrome can occur in any compartment after accidental injury, following elective surgical procedure or with infections and circumferential dressings.
In children, it is most commonly seen following fractures of supracondylar humerus and tibia.
A compartment syndrome of forearm may occur with or without brachial artery injury and in the presence or absence of radial pulse.
When it is mild, deep flexor muscles are involved particularly flexor digitorum profundus, producing flexor contracture deformity of one or more finger.
Excision of head of radius in a child should not be done because
A. It produces instability of elbow joint
B. It leads to secondary osteoarthritis of elbow
C. It causes subluxation of inferior radioulnar joint
D. It causes myositis ossificans
Answer- C. It causes subluxation of inferior radio-ulnar joint
Classically the head of radius should not be excised in children because-
A. It will interfere with synchronous growth of radius and ulna producing wrist and elbow deformity
B. It leads to proximal radial migration and subluxation of inferior radio-ulnar joint.
C. It causes weakness of extremity and discomfort in distal radio-ulnar joint with heavy activities.
D. May produce cubitus valgus deformity and instability
In fracture of the olecranon, excision of the proximal fragment is indicated in all of the following situations, except
A. Old ununited fractures
B. Non-articulated fractures
C. Fracture extending to coronoid process
D. Elderly patient
Answer- C. Fracture extending to coronoid process
