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Ortho con supra copy
- 1. ORTHOPEDIC CONFERENCE BY Ext.Prownapat, Ext.Teeradon 11/7/2019
- 2. Case เด็กชาย อายุ +ปี . เดือน • CC : ล้มตกจากโต๊ะสูง +.= เมตร ? ชัAวโมงก่อนมารพ. •PI : • 2 hour PTA ล้มตกจากโต๊ะสูง +.= เมตร ไม่ทราบลักษณะท่าลง ปวดแขนซ้าย แขนซ้ายบวม,ผิดรูป ไม่มีแผล ขยับแขนขวา และขาสองข้างได้ ปกติศีรษะไม่กระแทกพืPน ไม่หมดสติ ผู้ป่วยไม่ขยับแขนซ้าย จึงไปรพช. > on arm sling แล้ว referมา MNRH
- 3. Past history •No underlyingdisease •No previous surgery/trauma •No drug/food allergy •No current medication
- 4. Physical Examination • A: Can talk clearly ,Patent airway, no c-spine tenderness • B : Clear,equal breath sound both lungs • C : BP 139/78 mmHg, HR 120 bpm • D : E4V5M6 , pupil 3mm RTLBE • E : no external wound , no bleeding
- 5. Physical Examination • Vitalsigns- BT 36.5 c, PR 90 bpm, BP 139/76,RR 20/min • GA : A Thai boy, Alert, Good consciousness • HEENT : no pale conjunctivae, anicteric sclerae • CVS : Full, regular, symmetrical pulses all extremities, normal s1,s2,no murmur • Lungs : Normal breath sound in both lungs • Abdomen : Soft ,not tender, normoactive bowel sound • Back : not tender, no wound
- 7. Physical Examination • Lt.elbow : s shape deformity, swelling, no wound, tenderness, limit ROM due to pain, distal neurological exam can’t evaluate Capillary refill < 2 sec , radial pulse 2+, ulnar pulse 2+ • Lt. shoulder : no deformity, no wound, not tender, limit ROM due to pain • Lt. hand : no deformity, no wound, not tender, limit ROM due to pain
- 8. • Other limbs: not tender , full ROM , no wound, can active move Physical Examination
- 9. Investigation •Film Left elbowAP, lateral
- 11. Film interpretation • Completetransverse fracture at supracondylar region of left humerus with totally posteromedial displacement • Abnormal anterior humoral line and Baumann’s angle • +ve posterior fat pad sign • surrounding soft tissue swelling
- 12. Diagnosis Left supracondylar fractureGartland type III
- 13. Parameters • Baumann angle Modifiedbaumann N:64-81 Baumann N:9-26
- 14. • Anterior humeralline > supracondylar fracture Parameters Anterior humeral line capitellum
- 15. • Radiocapitellar line >presence of radial head subluxation or dislocation Parameters
- 16. Supracondylar fracture • Type •Extension type(97.7%) • Flexion type(2.3%) • Clinical presentation • Pain and swelling • S-shaped deformity • Loss of passive and active motions/pseudoparalysis
- 18. Supracondylar fracture • Gartland’sClassification I Non-displaced fracture II Partially displaced , intact Posterior cortex III Totally displaced
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- 22. Treatment • Initial Temporary splint/immobilize
- 23. • Gartland type1 : Long arm cast / Locking slab • Gartland type 2 : Close reduction + Long arm cast / Locking slab +/- Pinning • Gartland type 3 : Close reduction + Pinning + Long arm cast / Locking Slab Treatment
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- 26. • Gartland typeIV !!!!! • Complete periosteal disruption with instability in flexion and extension • Diagnosed with examination under anesthesia during surgery • Treated with most commonly with CRPP or open reduction if needed
- 27. Indication for openreduction • 1. Inadequate reduction with close reduction • 2. Vascular injury • 3. Open fracture
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- 30. Post operation care •Elevation / swelling control • Pain control • Observe for compartment syndrome • Observe for nerve , vessel injury • Remove pins and cast at 3-4 weeks / union • ROM exercise ,Strengthening exercise arm forearm, wrist, hand
- 31. Complications • Early 1. Anteriorinterosseous nerve injury 2. Brachial artery injury 3. Compartment syndrome • Late 1.Cubitus varus 2.Elbow stiffness