Elbow fracture (peds): Difference between revisions
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==Lateral | ==[[Lateral epicondyle fracture (peds)]]== | ||
===Background=== | ===Background=== | ||
*Salter-Harris type IV Fx | *Salter-Harris type IV Fx | ||
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*Often requires ORIF (ortho consult) | *Often requires ORIF (ortho consult) | ||
==Medial | ==[[Medial epicondyle fracture (peds)]]== | ||
===Background=== | ===Background=== | ||
*Not true Salter-Harris fx (apophysis, not physis, is involved) | *Not true Salter-Harris fx (apophysis, not physis, is involved) | ||
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*Ortho consult | *Ortho consult | ||
==Olecranon | ==[[Olecranon fracture (peds)]]== | ||
===Diagnosis=== | ===Diagnosis=== | ||
*Often occur in a/w fx of radial head/neck | *Often occur in a/w fx of radial head/neck | ||
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*Orthopedic consultation is best to guide treatment | *Orthopedic consultation is best to guide treatment | ||
==Radial | ==[[Radial head fracture (peds)]]== | ||
===Management=== | ===Management=== | ||
*Ortho consultation to guide treatment | *Ortho consultation to guide treatment | ||
Revision as of 19:22, 29 September 2014
Differential Diagnosis
Elbow Diagnoses
Radiograph-Positive
- Distal humerus fracture
- Radial head fracture
- Capitellum fracture
- Olecranon fracture
- Elbow dislocation
Radiograph-Negative
- Biceps tendon rupture/dislocation
- Lateral epicondylitis
- Medial epicondylitis
- Olecranon bursitis (nonseptic)
- Pronator teres syndrome
- Septic bursitis
Pediatric
- Nursemaid's elbow
- Supracondylar fracture
- Lateral epicondyle fracture
- Medial epicondyle fracture
- Olecranon fracture
- Radial head fracture
- Salter-Harris fractures
Lateral epicondyle fracture (peds)
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 won't intersect middle of capitellum in all views
- May be only sign of fracture if fracture is entirely through growth plate
- +Fat Pad Sign/"sail" sign
- May be only sign of nondisplaced fx
Treatment
- Often requires ORIF (ortho consult)
Medial epicondyle fracture (peds)
Background
- Not true Salter-Harris fx (apophysis, not physis, is involved)
- 50% assoc 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)
- If think is trochlear but cannot see medial epicondyle fragment is medial epicondyle
- Fat pad sign not usually present because most injuries are extra-articular
Treatment
- Ortho consult
Olecranon fracture (peds)
Diagnosis
- Often occur in a/w fx of radial head/neck
Treatment
- If displaced <5 mm immobilize in stable position (usually 45 degrees of elbow flexion)
- ORIF indicated for unstable fracture
- Orthopedic consultation is best to guide treatment
Radial head fracture (peds)
Management
- Ortho consultation to guide treatment
- ORIF indicated when angulation >60 degrees or displacement >50%
See Also
Source
- Tintinalli
- UpToDate