Diferencia entre revisiones de «Medial epicondyle fracture (peds)»
(Text replacement - "fx " to "fracture ") |
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| (No se muestran 21 ediciones intermedias de 3 usuarios) | |||
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==Background== | ==Background== | ||
*Not true Salter-Harris fracture (apophysis, not physis, is involved) | *Not true Salter-Harris fracture (apophysis, not physis, is involved) | ||
*50% | *50% associated with [[elbow dislocation]] | ||
==Diagnosis== | {{Proximal arm fracture DDX}} | ||
==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 DDX}} | |||
==Evaluation== | |||
[[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 | *May become entrapped within elbow joint | ||
*Use [[CRITOE]] to determine if bone in joint is medial epicondyle or | *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 | **If think is trochlear but cannot see medial epicondyle fragment is medial epicondyle | ||
***(Medial epicondyle normally ossifies before the trochlea) | ***(Medial epicondyle normally ossifies before the trochlea) | ||
*Fat pad sign not usually present because most injuries are extra-articular | *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<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]