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Noon conference
- 1. Noon Conference Ext. Wittawat Kittivisuit
- 3. History • A Thai 6 years old boy fall from height 4 hr PTA. There is no history of head trauma, no amnesia, no lucid interval. After falling he can stand up by his own and no weakness. He has pain at left elbow and deformity. He can’t move his left arm because of the pain but there is no numbness all distal to deformity
- 5. NORMAL
- 7. Film
- 10. Diagnosis
- 11. Lateral Condyle Fracture Jakob II
- 12. Set OR for Close Reduction and External Fixation with K-wire with Posterior Long Arm Slab
- 18. Treatment • Nonoperative long arm casting – indications • only indicated if < 2 mm of displacement, which indicates the cartilaginous hinge is most likely intact • sub-acute presentation (>4 weeks) – technique • cast with elbow at 90 degrees and forearm supination • weekly follow up • total length of casting is 3-7 weeks
- 19. Treatment • Operative Close reduction with percutaneous pin fixation indications • somewhat controversial, but Weiss et al suggest fractures with < 4 mm of displacement have intact articular cartilage and can be treated with CRPP
- 20. Treatment • Operative(cont) Open reduction and fixation indications – if > 2-4mm of displacement – any joint incongruity – fracture non-union
- 21. Complication • Nonunion • AVN • Malunion- cubitus valgus due to growth arrest • Tardy ulnar nerve palsy • Growth arrest
- 22. For GP • Just divide to two group Jakob I and not Jakob I • Not Jakob I refer • Tardy ulnar palsy can occur after fracture 10-20 years don’t forget about history of trauma can lead to deformity and nerve palsy in the future • If unsure on slab and follow up film next week fracture line can see crystal clear if there is fracture
- 23. Thank