Diferencia entre revisiones de «Medial epicondyle fracture (peds)»
| (No se muestran 8 ediciones intermedias del mismo usuario) | |||
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==Clinical Features== | ==Clinical Features== | ||
*Mechanisms: | *Mechanisms: | ||
**Posterior elbow dislocation | **Posterior [[elbow dislocation]] | ||
**Repetitive stress ("Little League elbow") | **Repetitive stress ("Little League elbow") | ||
*Exam: pain with pronation or elbow/wrist flexion | *Exam: pain with pronation or elbow/wrist flexion | ||
*May have associated [[ulnar nerve injury]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
[[File:PMC4635321 rjv13301.png|thumb|Pediatric medial epicondyle fracture.]] | [[File:PMC4635321 rjv13301.png|thumb|Pediatric medial epicondyle fracture.]] | ||
===Workup=== | |||
*AP and lateral elbow x-ray | |||
**Consider comparison views of other elbow | |||
===Diagnosis=== | |||
*Displacement of medial epicondyle ossification center | *Displacement of medial epicondyle ossification center | ||
*May become entrapped within elbow joint | *May become entrapped within elbow joint | ||
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==Management== | ==Management== | ||
* | *Reduction, if concurrent [[elbow dislocation]] | ||
** | *[[Posterior long-arm splint]] with forearm pronated | ||
*Typically discussed with ortho consultant while in ED | |||
==Disposition== | ==Disposition== | ||
*If nonoperative, follow up with pediatric orthopedist within 5-7 days | |||
== | ==Specialty Care== | ||
* | *Long arm cast with elbow flexed 90˚ vs operative management<ref>https://www.orthobullets.com/pediatrics/4008/medial-epicondylar-fractures--pediatric</ref> | ||
==See Also== | ==See Also== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
Revisión actual - 21:35 22 jun 2020
Background
- Not true Salter-Harris fracture (apophysis, not physis, is involved)
- 50% associated with elbow dislocation
Humerus Fracture Types
Clinical Features
- Mechanisms:
- Posterior elbow dislocation
- Repetitive stress ("Little League elbow")
- Exam: pain with pronation or elbow/wrist flexion
- May have associated ulnar nerve injury
Differential Diagnosis
Elbow Diagnoses
Radiograph-Positive
- Distal humerus fracture
- Radial head fracture
- Capitellum fracture
- Olecranon fracture
- Elbow dislocation
Radiograph-Negative
- Biceps tendon rupture/dislocation
- Lateral epicondylitis
- Medial epicondylitis
- Olecranon bursitis (nonseptic)
- Pronator teres syndrome
- Septic bursitis
Pediatric
- Nursemaid's elbow
- Supracondylar fracture
- Lateral epicondyle fracture
- Medial epicondyle fracture
- Olecranon fracture
- Radial head fracture
- Salter-Harris fractures
Evaluation
Workup
- AP and lateral elbow x-ray
- Consider comparison views of other elbow
Diagnosis
- Displacement of medial epicondyle ossification center
- May become entrapped within elbow joint
- Use CRITOE to determine if bone in joint is medial epicondyle or normal trochlear osseus center
- If think is trochlear but cannot see medial epicondyle fragment is medial epicondyle
- (Medial epicondyle normally ossifies before the trochlea)
- If think is trochlear but cannot see medial epicondyle fragment is medial epicondyle
- Fat pad sign not usually present because most injuries are extra-articular
Management
- Reduction, if concurrent elbow dislocation
- Posterior long-arm splint with forearm pronated
- Typically discussed with ortho consultant while in ED
Disposition
- If nonoperative, follow up with pediatric orthopedist within 5-7 days
Specialty Care
- Long arm cast with elbow flexed 90˚ vs operative management[1]