upper limb fractures Flashcards
Lateral condyle fractures
* how are they classified
* what is wrong with milch classification
* investigations
* why is it hard to decide on undisplaced fractures
* goals of treatment
* how do you manage them
* what are the complications associated with them
Jakob classification
1. undisplaced <2mm - cartilaginous hinge
2. moderately displaced (2- 4mm)
3. >4mm displaced and rotated
Milch classification
doesnt guide management
Investigations
* AP and lateral xrays
* internal oblique xray - picks up 70% more fractures
* US and MRI
* EUA and arthrogram - distal humerus is cartilaginous, so difficult to assess intra-articular component in undisplaced fractures
Goals of treatment
* restore the articular congruity
* avoid secondary displacement
* avoid overgrowth due to fracture instability or non-union
Management
undisplaced <2mm in all planes and intact medial hinge
* above elbow cast 6 weeks - weekly xrays for 3 weeks
displaced and intact articular surface
- arthrogram
- percutaneous pinning
- 1.6mm k-wires
displaced and articular surface not intact
- ORIF - wires or screws
- direct lateral approach to distal humerus
- preserve periosteum.- no posterolateral stripping - BLOOD SUPPLY
Complications
- stiffness - most common
- non-union
- fishtail deformity - central area of avascular necrosis
- cubitus valgus and tardy ulnar nerve
Leg length discrepancy
- causes
-
Causes
- true - congenital and acquired
- apparent
TRUE
Congenital:
- Hip - DDH, coxa vara
- Femur - PFFD
- tibia/ fibular - tib/ fib hemimelia
- Foot/ ankle - unilateral club foot
- whole limb - skeletal dysplasia - hemihypertrophy or hemi atrophy
Acquired
- Inflammatory - JIA (overgrowth)
- neurological - polio, spinal dysraphism
- traumatic - physeal fracture or diaphyseal fracture (shortening)
- Infection - septic OA (physis injury) or diaphyseal OM - bone hyperaemia
- radiotherapy - physeal damage
APPARENT
- flexion adduction contractures
- fixed pelvic obliquity
- scoliosis
- hip contractures - CP
