The document discusses an x-ray of a medial epicondyle fracture in a patient's elbow. It provides 6 multiple choice questions regarding fractures and dislocations around the elbow joint in pediatric patients. The questions cover topics like appropriate treatment for a displaced medial epicondyle fracture, fracture patterns associated with elbow dislocations in children, reasons that may require open reduction and internal fixation of a fracture, muscles involved in certain avulsion injuries, appropriate next steps in managing a reduced elbow fracture, and potential causes of continued incongruity following reduction of an elbow dislocation.

1. X-RAY DISCUSSION
Dr. Madhusudhan NC
Resident-Dept. of Orthopaedic Surgery
Bangalore Baptist Hospital

6. X-ray showed

7. So this is a case of……..
Medial Epicondyle Fracture
And not Medial Condyle Fracture!!!

37. 1. A 15 year old little league pitcher sustains an injury to his dominant elbow
shown in Figure A. Radiographs demonstrate 7 mm of displacement. Which
of the following treatments will result in the highest rate of bony union?
1. Long arm cast for 1 week, followed
by passive and gentle active ROM.
2. Placement in a hinged elbow brace
with immediate active motion.
3. Closed reduction followed by
K-wire fixation.
4. Open Reduction and internal
fixation.
5. Fragment excision and
flexor/pronator mass re-attachment.

38. 2. Which of the following fracture patterns (Figure A-E) is most commonly
associated with a combined ulno-humeral and radio-capitellar elbow dislocation
in children?
1. Figure A
2. Figure B
3. Figure C
4. Figure D
5. Figure E

39. 3. A 9 year old boy fell off a swing set and injured his left elbow. Radiographs
are shown in Figures A and B. Open reduction and internal fixation of this
fracture is indicated secondary to which of the following?
1. Displacement of greater than 5mm.
2. An incarcerated fragment in the ulnohumeral joint.
3. 2+ valgus laxity seen with manual stressing.
4. To prevent cubitus valgus deformity.
5. High risk of symptomatic non-union of fragment.

40. 4. Which of the following muscles is involved in the avulsion injury that creates
the fracture shown in figure A?
1. Pronator Quadratus.
2. Pronator teres.
3. Extensor carpi radialis longus.
4. Brachioradialis.
5. Brachialis.

41. 5. A 7 year old boy presents to the emergency room with a left elbow injury
after falling off of the monkey bars. His neurovascular examination in the
extremity is normal and his pain is controlled. Post-reduction radiographs are
shown in Figure A. What is the next most appropriate step in management?
1. Percutaneous pinning.
2. Hinged elbow brace locked at 90* of flexion for 10 days followed by gentle
passive range of motions.
3. ORIF
4. Long arm cast for 4 weeks.
5. Sling for comfort and return to
activities as tolerated.

42. 6. A 11 year old child sustains an elbow dislocation. The Elbow is reduced, but
post-reduction radiographs demonstrate that the ulnohumeral joint remains
slightly incongruent. What is the most likely etiology for this continued
incongruency?
1. Interposed annular ligament.
2. Interposed lateral epicondyle fragment.
3. Interposed medial epicondyle fragment.
4. Interposed ulnar nerve.
5. Interposed brachialis muscle.

44. THANK YOU