5. Primary survey at MNRH
• A – can talk, no posterior midline neck tenderness, full ROM of neck
• B – trachea in midline, spontaneous breathing, CCT negative, clear
and equal breath sound
• C – BP 110/72 mmHg, PR 108 bpm, no external bleeding, PCT
negative
• D – E4V5M6 pupils 2mm RTLBE
• E – left elbow deformity with swelling and tender with limit ROM
7. Secondary survey
• A – no drug and food allergy
• M – no current medication
• P – no underlying disease, no history of surgery
• L – 18.00 8/3/61
• E – ตกจากกองดิน สูง1.5เมตร ศอกข้างซ้ายผิดรูป บวม ปวด ขยับไม่ได้ ไม่มีบาดแผลภายนอก
8. Head-to-toe examination
• Head and maxillofacial
• No wound, no facial deformity, no ecchymosis
• C-spine and neck
• No wound, no C-spine tenderness, full active ROM of neck
• Chest
• Trachea in midline, clear and equal breath sound both lungs,
CCT negative
• Abdomen and pelvis
• Not distend, no wound, soft, not tender, normoactive bowel,
PCT negative
9. Head-to-toe examination
• Musculoskeletal
• Deformity, tender and swelling at left elbow, limit ROM of left elbow
• Radial pulse 2+, capillary refill <2 sec, normal pinprick sensation
• Neurologic
• E4V5M6, pupils 2 mm RTLBE
• Motor grade V all except left elbow due to pain and deformity
• Perineum and rectum
• No ecchymosis
18. Epidemiology
• Children 5 - 7 years old
• Male = Female
• Types
• Extension - most common (95-98%)
• Flexion type (<5%)
• Mechanism of injury – fall on outstretched hand
19. • Symptoms
• Pain
• Refusal to move the elbow
• Physical examination
• Gross deformity of elbow – S-shaped deformity
• Swelling
• Bruising
• Limit active elbow motion/pseudoparalysis
Clinical presentation
20. • Neurapraxia – almost all resolve spontaneously
• Anterior interosseous nerve neurapraxia (branch of median n.)
• most common
• Radial nerve palsy
• Ulnar nerve palsy
• Flexion type
• Vascular injury (1%) – rich in collateral circulation
Associated injuries
23. Posterior fat pad
sign
lucency along the posterior
distal humerus and olecranon
fossa is highly suggestive of
occult fracture around the
elbow
24. Baumann’s angle
• Humeral-capitellar angle
• Humeral axis and a straight line through the epiphyseal plate of the
capitellum
• Normal: 64 - 81° or differ 5° between the two sides
25.
26. Gartland’s classification
I Non-displaced fracture
Anterior humeral line ✓
Baumann’s angle ✓
II
Displaced, intact
posterior cortex
Anterior humeral line ✘
Baumann’s angle +/-
III Totally displaced
Anterior humeral line ✘
Baumann’s angle ✘
