Extern conference Ext.สิทธิชน 29 ส.ค. 61

2. ผู้ป่วยเด็กชายไทยอายุ4 ปี
• CC: เจ็บบริเวณศอก 6 ชั่วโมงก่อนมาโรงพยาบาล
• PI: 6 ชั่วโมงก่อนมาโรงพยาบาล ญาติบอกว่าไปรับผู้ป่วยมาจากโรงเรียน คุณครูแจ้งว่าผู้ป่วยหกล้มเจ็บ
บริเวณข้อศอกขวา ขยับไม่ได้ ไม่มีแผลภายนอก บริเวณอื่นของร่างกายไม่ได้รับบาดเจ็บ
• Past history: no known underlying disease, no history of fracture
• Personal history: no drug/food allergies

3. Physical examination
Vital sign: T 36.8°C, BP 119/75 mmHg, RR 22 times/min, PR 125 bpm
GA: good consciousness
HEENT: no pale conjunctiva, anicteric sclerae, no ear/nasal discharge, no hoarseness
CVS: normal S1/S2, no murmur, full regular pulse
Lung: clear, equal both lung
Abdomen: soft, not tender
Extremities: Right arm  mild swelling at right distal forearm, no erythema, no warmth, no joint
swelling, limit ROM due to pain, good capillaries refill, radial and ulnar artery are intact, no
external wound
Neuro: E4V5M6, pupil 2 mm RTLBE, sensory cannot evaluate, distal neurological exam is normal,
limit ROM right elbow, other WNL

6. Diagnosis
Closed fracture right lateral condyle

8. Intro
• 17% of distal humerus fracture/ less common than supracondylar fracture
• Average age ~ 6 years old
• Rarely associated with injury outside the elbow region
• Rarely associate with neurovascular injury

9. Mechanism of injury
• Pull off theory
• Push off theory

10. Sign and symptom
• Asymptomatic ?
• Soft tissue swelling +- hematoma
• Pain + increased by flexing wrist + limit ROM
• Tender

11. Classification
• Milch’s classification —> anatomic location
• Jakob classification —> stage of displacement

12. Milch’s Classification —> by Anatomic location

13. Jakob classification —> by Stage of displacement

14. Jakob I

15. Jakob II

16. Jakob III

17. Salter and Harris

18. Treatment
• Jakob I —> long arm cast/locking slab
• Jakob II —> Closed reduction + Pinning + Long arm
cast/locking slab
• Jakob III —> Open reduction + Pinning + Long arm
cast/locking slab

19. Treatment

21. • Elevation —> swelling control
• Pain control
• Observe compartment syndrome
• Remove cast in 4 week
• Remove pin in 4-6 week ( can be delayed in older children )
Post operative care

22. Complication
• Lateral spur formation
• Elbow stiffness
• Cubitus varus > Cubitus valgus
• Delayed union and Non-union

23. Thank you!