A 3-year-old male presented with left elbow pain for 14 days following a fall on an outstretched hand. X-rays showed a lateral condylar fracture and displacement of the left humerus that was initially treated with closed reduction, casting, and a sling but the fracture worsened. The patient later underwent open reduction and internal fixation surgery and was recovering well with immobilization, antibiotics, and pain medication. On examination, the left upper limb was tender and immobilized while the right was normal with no neurological deficits found.

1. Case presentation
Orthopedics
Huzaifa Hamid Ahmad

2. Personal information
• Name: Eyan Nazm Osman
• Age: 3 years old
• Gender: male
• Blood Group: O+
• Address: Twimalik
• Date of addmision: 21/2/2015
• Date of examination: 22/2/2015

3. Chief Complaint
•Left elbow pain for 14 days duration

4. •History of present illness:
The condition started 2 weeks ago when the child was
playing at home on a sofa and then suddenly he fell
down on an out stretched left hand, he started crying,
he had pain which was so severe, radiating to the left
hand and shoulder, it was continuous, aggravated by
movement and relieved by immobilizing the elbow. No
any associated symptoms. The family saw that his left
elbow was somehow displaced, they applied gentle
pressure on the elbow and secured it with their hands.
Later on they took him to the emergency department.

5. • There was no open wound, no any bleeding, no
redness, no swelling ,but he couldn’t move his
affected hand. At the emergency department
immediately an X-Ray was done for him.
• The X-Ray showed lateral condylar fracture and
displacement of the left humerus. they did close
reduction, back slab and POP applied. Then the
family advised to take another X-Ray 3 days later.
They took another X-Ray but the fracture was not
reduced well, in fact the displacement increased.

6. • So the doctor decided to do an elective surgery to
reduce the fracture. Under GA open reduction and
internal fixation was done, early recovery no any
GA complication. He was on zero post-operative
day, irritable, passed urine, no stool passed. He
received Antibiotics in the form of injection and
syrup, with pain killers post operatively.

8. •Review of systems
• Gastrointestinal: -ve
• Respiratory: -ve
• Cardivascular: -ve
• Genito-urinary: -ve
• Central nervous system: -ve
• Musculoskeletal: mentioned
All negative

9. Previous injury:
no
Developmental History:
No any developmental milestones
Immunization history:
up to date
Drug history:
• No known drug allergies.
• Not on any chronic medication.
Past medical history:
• No DM, no HTN no asthma, no rickets.
• No previous admission.
Past surgical:
• Negative.
• No any blood transfusion.

10. Family history:
• No HTN, No DM
Social history:
• No passive smoker
• Own house
• Three family member
• Tap water
• No animal contact

11. Examination
•Vital sign:
• Blood pressure: 110/75 mmHg
• Pulse rate: 86 beat/min, regular, normal volume.
• Respiratory rate: 25 cycle/min
• Temperature: 37.2

12. •Physical examination:
• A male preschooler lying down on his bed,
conscious, alert, not cooperative, irritable, there is
no dyspnea, no cyanosis, no pallor, no jaundice, no
palpable lymph nodes. No clubbing, no bilateral
pitting leg edema.
•Look:
no any congenital anomaly of the hands, no swelling
of the affected hand, no erythema. There is a yellow
cannula on the dorsum of the right hand.
There was back slab and (POP) over the left upper
limb, extending from metacarpophalangeal joint to the
mid shaft of the humerus, resting on an arm sling.

13. Feel :
No any temp. change, the left hand was tender , I
could not feel the left limb, no crepitus, the pulses
of the right hand was palpable and normal, no
tenderness of the right hand.
Move :
Normal movement of the right hand, no any
limitation of movement.
On the left hand, there was only movement of the
fingers. All other movements were limited!

14. •Neurological examination:
Normal tone, power, reflex of the right upper limb, but
neurological examination of the left upper limb couldn’t be
done. Normal sensory,