0071643192.pdf

ORTHOPEDICS

LATERALEPICONDYLARFRACTURE

■ Very rare!

TREATMENT

Nondisplaced fractures can be stabilized with a posterior splint with the elbow

in 90° flexion and the forearm in supination.

A six-year-old presents after falling off the jungle gym at school. The

patient is diagnosed with a supracondylar fracture. The boy’s arm is splinted

with pulse, motor, and sensation intact. The patient is sent home and given

instructions to follow up with orthopedics in 48–72 hours. When Mom presents to

the orthopedist, she states that he has been crying almost nonstop since the acci-

dent. What complication might have occurred?

Always consider compartment syndrome with supracondylar fractures and

any fracture involving the forearm. If untreated, forearm ischemia can lead to

Volkmann’s ischemic contracture.

DISTALHUMERUSSUPRACONDYLARFRACTURE

Accounts for 60% of elbow fractures in children

MECHANISM

The vast majority are due to FOOSH with hyperextension of elbow.

DIAGNOSIS

X-ray shows presence of posterior fat pad sign and anterior displacement of

the anterior humeral line (see Figure 4.9).

TREATMENT

■ Nondisplaced supracondylar fractures can be immobilized in posterior

splint.

■ Displaced fractures require urgent orthopedic reduction and pinning.

COMPLICATIONS

Complications include injuries to the brachial artery, median nerve (anterior

interosseous nerve), compartment syndrome and Volkmann’s ischemic con-

tracture,and can also result in radial and ulnar nerve injury.

POSTERIORELBOWDISLOCATION

By far the most common elbow dislocation; typically results from FOOSH

DIAGNOSIS

■ Posterior prominence of the olecranon with swelling and 45° of joint

flexion

■ Exam with posterior prominence of the olecranon with swelling and 45°

of joint flexion

■ X-ray shows a posteriorly displaced radius and ulna.

FIGURE 4.9. Supra-

condylar fracture of the

humerus. Note displaced fat

pads (arrow) signifying joint

effusion. A line along the

anterior cortex of the

humerus should pass

through the middle third of

the capitellum on a true

lateral view for a normal

elbow.

Elbow fractures (particularly of

the radial head) can be occult

on radiograph so look for a

posteriorfat pad sign, which is

alwayspathologic. A large

anterior fat pad (sail sign) can

also sometimes be pathologic.