Elbow fracture (peds): Difference between revisions
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==Supracondylar Fracture==
==Supracondylar Fracture==
* 7% have nerve injury (median & radial most common)
*See [[Supracondylar Fracture]]
* Can get ischemia due to brachial artery compression from increased compartment pressure


==Lateral Epicondyle Fracture==
===Background===
*Salter-Harris type IV Fx
*Neurovascular injury uncommon
===Diagnosis===
===Diagnosis===
* Anterior humeral line does NOT intersect middle third of capitellum
====Clinical Findings====
* Small anterior fat pad sometimes normal, posterior fat pad always abnormal
*Swelling and tenderness limited to lateral elbow
 
neurovascular injury is uncommon
===Classificiation===
====Imaging====
* Type I - Nondisplaced
*Obtain oblique view if suspicion high despite neg AP/Lat
* Type II - Displaced w/ intact posterior cortex
*Radiocapitellar line does NOT intersect middle of capitelum in all views
* Type III - no cortical contact
**May be only sign if fracture is entirely through growth plate
*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!)
*+Fat Pad Sign
 
**May be only sign of nondisplaced fx
===Treatment===
===Treatment===
* Type I
*Often requires ORIF (ortho consult)
** 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==
==Medial Epicondyle Fracture==
===Background===
*Not true Salter-Harris fx (apophysis, not physis, is involved)
*50% a/w elbow dislocation
===Diagnosis===
===Diagnosis===
* Radiocapitellar line does NOT intersect the middle of the capitelum in all views
*Displacement of medial epicondyle ossification center
* May be only sign if fracture is entirely through the growth plate
*May become entrapped w/in elbow joint
* Fat Pad Sign
*Use CRITOE to determine if bone in joint is medial epicondyle or nl trochlear oss center
* May be only sign of nondisplaced fx
**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


==Medial Epicondylar Fractures==
===Treatment=
===Diagnosis===
*Ortho consult
* 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==
==See Also==
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==Source==
==Source==
UpToDate
Tintinalli, UpToDate


[[Category:Peds]]
[[Category:Peds]]
[[Category:Ortho]]
[[Category:Ortho]]

Revision as of 00:57, 27 June 2011

Supracondylar Fracture

Lateral Epicondyle Fracture

Background

  • Salter-Harris type IV Fx
  • Neurovascular injury uncommon

Diagnosis

Clinical Findings

  • Swelling and tenderness limited to lateral elbow

neurovascular injury is uncommon

Imaging

  • Obtain oblique view if suspicion high despite neg AP/Lat
  • Radiocapitellar line does NOT intersect middle of capitelum in all views
    • May be only sign if fracture is entirely through growth plate
  • +Fat Pad Sign
    • May be only sign of nondisplaced fx

Treatment

  • Often requires ORIF (ortho consult)

Medial Epicondyle Fracture

Background

  • Not true Salter-Harris fx (apophysis, not physis, is involved)
  • 50% a/w elbow dislocation

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 or nl 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

==Treatment

  • Ortho consult

See Also

Ortho: Elbow Fracture

Ortho: Elbow (Minor)

Peds: Supracondylar

Rads: Elbow Xray Peds

Source

Tintinalli, UpToDate

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