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Fracture around elbow and hand
The document discusses various types of elbow and hand fractures, focusing on their anatomy, classifications, clinical features, management, and potential complications. It highlights supracondylar fractures as the most common in children and details treatment options like closed reduction and open reduction with internal fixation. Additionally, it addresses other specific fractures around the elbow and hand, such as lateral condyle and Bennett fractures, along with their treatment procedures.
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Fracture around elbow and hand
- 1. Fracture around elbowand hand Maj. Dr. Dipendra Maharjan
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- 3. Three Bony pointsRelationship
- 4. Injuries Around theElbow Fractures Distal Humeral Fractures Supracondylar fracture Lateral condyle fracture Medial condyle fracture Medial epicondyle fracture Capitellar fracture Radial head/neck fracture Olecranon fracture Dislocations Elbow joint dislocation Radial head dislocation (Pulled elbow/ Nurse maid’s elbow)
- 5. Supracondylar Fracture CommonestFracture of elbow region (68%) Peak range 5-6 years Fracture line passes just proximal to the bone masses of trochlea capitulum and often runs through the apices of coronoid and olecranon fossae
- 6. Why common inchildren? Bony architecture at the supracondylar region is weak and vulnerable because: Bone is remodelling It is less cylindrical Metaphysis is just distal to 2 fossae, coronoid and radial fossa Here the cortex is thin Anterior cortex has a defect in the area of coronoid fossa Laxity of ligaments permits hyperextension at the elbow
- 7. Types Gartland Classification 97.7 % extension type 2.3 % flexion type
- 8. Clinical Features • Historyof fall • Pain and inability to use limb. • Swelling • Deformity (S-shaped) • Bruise • Crepitus • Signs of neuro-circulatory compromise (if present)
- 9. There may sometimesbe puckering of the skin when the proximal Fragment has penetrated the brachialis and anterior fascia of the elbow Dimple sign
- 10. Relationship to neurovascularstructures
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- 12. Anterior humeral lineShaft-condylar angle Fat pad sign Fish tail sign
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- 15. MANAGEMENT OF S/C# • Close reduction • Surgery – CRPP ( closed reduction and percutaneous pinning) – Open reduction and internal fixation
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- 17. Percutaneous pinning Beforethe development of the fluoroscopic unit, blind pinning was performed Modern imaging techniques and improved power equipment have made percutaneous pinning the standard treatment.
- 18. Percutaneous pinning.... Lateral pinningCrossed pinning Lateral pin
- 19. ORIF Indications of ORIF Closed reduction may not be possible because of interposed soft tissue or neurovascular bundle. When there is gross swelling of elbow so that hyperflexion is not possible after reduction. Injury to neurovascular bundle After open reduction of the fracture, fixed with pins. Good callus should be observed at the fracture before pin removal, generally 3 to 4 weeks after injury. The most frequent complication of surgical management appears to be a loss of range of motion.
- 20. Early complications Neurological involvement(10- 20%) Recovery usually occures in 2 to 2 ½ months Vascular Involvement
- 21. Physeal damagedue to repeated manipulation Compartment syndrome (1%)
- 22. Delayed complication Lossof mobility/Elbow stiffness Average loss of 4 degree with close reduction and 6.5 degrees with open reduction Myositis Ossificans Cubitus Varus
- 23. Lateral Condyle Fracture Most common distal humerus epihyseal injuries 2nd most common to supracondylar fracture
- 24. Classification: Milch TypeI: Fracture line courses medially to the trochlea through and into the capitellar-trochlear groove Type II: fracture line extends into the area of the trochlea
- 25. Different stages ofdisplacement of lateral condylar fracture: Undisplaced (A), Moderately displaced (B), and Completely displaced and rotated (C).
- 26. Fracture ofnecessity: Fracture invariably displaces if not treated operatively
- 27. Management Undisplaced fracture:Cast application (Needs Close monitoring) Displaced fracture: ORIF
- 28. Different methods oflateral condyle fixation
- 29. Complications Non-Union CubitusValgus deformity Tardy ulnar nerve palsy Osteoarthritis Osteonecrosis of capitellum
- 30. Intercondylar Fracture Occursbetween medial and lateral condyles of distal humerus Condyles split and with metaphyseal diaphyseal fracture Takes the shape of Y or T Badly comminuted and displace Operative management K wires Plating Cannulated cancellous screws
- 31. Medial Humeral CondyleFracture Rare 1% of pediatric elbow fracture Slight older children Caused by direct fall onto the elbow or a fall onto an outstretched hand with the elbow in a varus position
- 32. • Kilfoyle classification –Greenstick or impacted fracture – Fracture through the humeral condule into the joint with little or no displacement – Epiphyseal fracture that is intraarticular and involves the medial condyle with the fragment displaced and rotated
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- 34. Pulled Elbow Traumaticsubluxation of the radial head produced by sudden traction on the hand with the elbow extended and the forearm pronated
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- 36. Fracture around Hand Bennett Fracture Rolando Fracture Thumb carpometacarpal joint dislocation Fingers Metacarpal Fracture Intra-articular fracture of the fifth metacarpal base Metacarpal shaft or neck fracture Metacarpal head fracture Middle or proximal phalanx fracture
- 37. Treatment Consevative management Buddy strapping POP slab Operative management CRPP Mini plate Mini screw K wire fixation External fixators
- 38. Bennett Fracture 1882,Bennett, Irish surgeon An intraarticular fracture through the base of the first metacarpal in which the shaft is laterally dislocated by the unopposed pull of the abductor pollicis longus
- 39. Treatment Reductionby traction is easy but is difficult to maintain CRPP ORIF
- 40. Rolando Fracture Communitedfirst metacarpal base fracture 1920, Rolando Y shaped fracture involving the thumb metacarpal base that usually doesnot result in diaphyseal displacement.
- 41. Reverse Bennett Fracture Intra-articular fracture at the base of the fifth metacarpal Pull of extensor carpai ulnaris Displace metacarpal shaft proximally Similar to Bennett fracture
- 42. Metacarpal Fracture Metacarpalsare vulnerable to blows and falls upon the hand or the longitudinal force of the boxers punch Fracture at Base Shaft Neck Head Treatment Conservative Operative
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Editor's Notes
- #14 It is a radiographic measurement in AP vies x-ray. It is the angle formed by drawing line along midline of diaphysis of humeral shaft, a line perpedicular to the midline and a line along the physis of lateral condyle. The angle A is original Baumann’s angle and B is used commonly. Normal Baumann’s angle is 64 to 81 degrees. Average is 72 degrees (Williamson).
- #15 It is a radiographic angle in AP view. A longitudinal line is drawn through long axis of diaphysis and widest part of metaphysis. The angle between the proximal part of diaphyseal line and lateral part of metaphyseal line is meataphyseal-diaphyseal angle. Normal angle is 90o. Angle greater than 90 degree denotes cubitus varus and lesser than 90 degrees denotes cubitus valgus.