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Injuries around the elbow

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Injuries around the elbow

  1. 1. Prepared by: Dr. Mostafa Azab Lecturer of Orthopedic Surgery Cairo University
  2. 2. Supracondylar Fracture of the Humerus Is a fracture, usually of the just abovehumerusdistal the , although it mayepicondyles occur elsewhere. While relatively rare in adults it is one of the most common fractures to occur in children and is often associated with the development of serious complications.
  3. 3. Classification: Flexion Type:20%Extension Type:80%
  4. 4. TYPES: There are three types based on the degree of separationof the fractured fragments: 1-Type I: undisplaced or minimally displaced fractures. 2-Type II: partially displaced. 3-Type III: fully displaced.
  5. 5. Epidemiology 1-This is the most common elbow fracture in children. 2-About 60% of fractures in children. 3-It is most common in children <10. 4- Peak incidence is between the ages of 5-8 years of age. 5-Primarily in children who are around age 7 years.
  6. 6. Presentation: The child presents with history of a falling on an outstretched hand . Followed by pain, swelling and inability to move the affected elbow. On examination: Unusual prominence of olecranon process but because it is a supracondylar fracture, the three bony point relationship is maintained, as in a normal elbow.
  7. 7. Complications: 1- Brachial Artery Injury 2- Nerve Injuries 3-Volkmann’s Ischaemic contracture 4-Myositis ossificans 5-Mal-union(Cubitus Varus)
  8. 8. Cubitus Varus
  9. 9. Treatment
  10. 10. Treatment: Closed Reduction& percutaneus Fixation
  11. 11. Lateral Humeral Condyle Fractures Lateral condyle fractures are common and their outcomes have historically been worse than supracondylar fractures articular nature, and often, missed diagnosis lead to an unacceptably high incidence of malunion and nonunion.
  12. 12. Epidemiology & Types: 6 Years old is the commonest age
  13. 13. Classification: Type I: SH Type IV TypeII: SH TypeII
  14. 14. According to Displacement: Classification based on fracture displacement: Type 1: displacement <2mm, indicating intact cartilaginous hinge Type 2: displacement 2- 4mm, displaced joint surface Type 3: displacement >4mm, joint displaced and rotated
  15. 15. Diagnosis: Physical exam: Exam may lack the obvious deformity often seen with supracondylar fractures. Swelling and tenderness are usually limited to the lateral side. Imaging: Radiographs: If the lateral condyle and capitellum have not ossified then radiographic findings can be subtle. Contra-lateral radiographs are very important. MRI and arthrograms can be helpful as well best judge if intra-articular incongruity.
  16. 16. X-Rays
  17. 17. Treatment Nonoperative long arm casting: Indications : Only indicated if < 2 mm of displacement, which indicates the cartilaginous hinge is most likely intact. Technique follow patient very closely (every 4-5 days) Operative CRPP: Indications: closed reduction achieves adequate reduction with no evidence of intra-articular incongruity Technique. Divergent pin configuration most stable open reduction and percutaneous pinning Indications: if > 2mm of displacement any joint incongruity Technique: Kocher lateral approach used avoid dissection of posterior aspect of lateral condyle (source of vascularization) intraoperative arthrograms are valuable to delineate the fracture and ensure anatomic reduction
  18. 18. Complications 1-Lateral overgrowth bump 2-AVN posterior dissection can result in lateral condyle osteonecrosis 3-Nonunion/malunion : caused from delay in diagnosis and improper treatment may result in cubitus valgus and tardy ulnar nerve palsy
  19. 19. Cubitus Valgus
  20. 20. Pulled Elbow(Nursemaid’s Elbow)  Age: 1 to 4 yrs  Elbow is pronated and flexed  Painful movements
  21. 21. Reduction
  22. 22. OTHER INJURIES FREQUENCYINJURYELBOWPEDIATRIC REQUIRES ORPEAK AGE% ELBOW INJURIES FRACTURE TYPE Majority741%SUPRACONDYLA R FRACTURE Rare328%RADIAL HEAD Majority611%LATERAL CONDYLE Minority118%MEDIAL EPICONDYLE Minority105%RADIAL HEAD AND NECK # Rare135%ELBOW DISLOCATION Rare101%MEDIAL CONDYLE #
  23. 23. Distal Radial Injuries In Adults In Children
  24. 24. Salter Harris Classification I – S = Slip (separated or straight across). Fracture of the cartilage of the physis (growth plate) II – A = Above. The fracture lies above the physis, or Away from the joint. III – L = Lower. The fracture is below the physis in the epiphysis. IV – T = Through. The fracture is through the metaphysis, physis, and epiphysis. V – R = Rammed (crushed). The physis has been crushed.
  25. 25. X-Rays
  26. 26. Complications: Growth Arrest & Deformity(Madlung Def.)
  27. 27. Principles of Treatment Anatomical Reduction Fixation by non-threaded wires Early mobilization
  28. 28. Anatomical Features
  29. 29. Colle’s Fracture Extra-articular fracture of the cancellous bone of the distal end of the Radius Displacement: 1-Shortening 2-Radial Deviation 3- Dorsal Angulation
  30. 30. Displacement
  31. 31. Mechanism of Injury Fall on the outstretched hand
  32. 32. Classification Type I: extra articular, undisplaced Type II: extra articular, displaced Type III intra articular, undisplaced Type IV: intra articular, displaced
  33. 33. Diagnosis -History -Pain -Swelling -Deformity -Loss of function -Neuro-vascular
  34. 34. Treatment Closed Reduction and casting
  35. 35. Treatment Closed Reduction and percutaneus pinning
  36. 36. Treatment External Fixation
  37. 37. Treatment Open Reduction & Internal Fixation
  38. 38. THANK U
  39. 39. Epiphyseal Injuries
  40. 40. THANK UU

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