1. Freih Odeh Abu Hassan
F.R.C.S.(Eng.),F.R.C.S.(Tr.&Orth)
Professor Of Orthopaedics
University Of Jordan
Pearls and Pitfalls
2. 1= High rate of complications
2= Results of non operative R/ are not always good.
3= > skeletally immature ( 5-10 y)
4=The child’s elbow is well
vascularized # healing very
quickly.
Different from many other pediatric injuries!!!
13. 1-Simple splint in the same
position then x-ray
2-In limb ischaemia align #
3-Avoid flexion
4- Record pulse & sensation
14. 1A- Long arm splintremove 1w
X-ray Splint for 2 w
1B (med.column collapse) CR+cast
=Avoid elbow flexion > 90°
=Insist on elevation
=Missed inj.
=Med.column collapse
Type I fracture
20. =CR + Percut. Pins + 3 w cast
Medial and lateral cross-pin technique is the gold standard, but it places the ulnar nerve at risk.
Type III fractures
34. 1-Arterial injury (5–12%)
A pulseless but pink hand can be observed.
Decrease flexion
2-C.Syndrome
3-Nerve Palsy
35. A pulseless white hand after CR and pinning open exploration with a vascular surgeon.
The anteromedial approach provides good exposure for the vascular repair and OR.
36. Nerve injuries
Loss of sensation & sweating
= 5–19% always neurapraxias.
= 3–6 months to resolve .
=The anterior interosseous N
39. 1=VIC due to immobilization in hyperflexion
2=Malunion
=Due to rotation “gunstock”
deformity (cubitus varus).
=Inadequate correction of medial
collapse.
= Wait 2years then correct
46. = Be aware of the
*Fracture patterns,
*Relevant anatomy - blood supply
*Risk of nonunion,
*Postop. follow-up in order to assess
potential deformity and neurologic
sequelae.
47. Diagnosis
AP + Lat. + Oblique view
Milch Type I
Travels from the metaphysis of the distal humerus through the distal lateral epiph. and through the trochleocapitellar groove.
48. Milch Type II
Travels from the distal lateral humeral metaphysis above the epiphysis and exits through the trochlea.
51. Stage I
Posterior splint vs. long arm cast
CLOSE FOLLOW-UP
because of high incidence of late
displacement and eventual nonmalunion .
52. Stage II/III
CR + percut. pins if reducible closed.
If not, ORIF + percut. pins
Post-operative Management
Long arm cast at 90 degrees until
radiographic healing
Polyglycolic acid pins
53. =Exposure bet. Brachio R + Triceps.
= Avoid post. dissection of the
fragment to preserve the vascular
supply.
=Careful elevation of the ant. capsule
and dissection to the medial extent
of the fracture fragment.
65. Not involve the joint surface or growth cartilage.
The medial epicondyle is a postero- medial structure that serves as the origin of the flexor–pronator muscle mass + medial collateral lig. complex
67. Non-surgical R/ of isolated medial epicondyle # with 5 –15 mm displacement yielded results similar to those obtained with ORIF
Farsetti P, etal
JBJS-A 2001.
68. Operative R/ of med. epicondyle #
= < 10 y old ORIF (K-wire) and
remove at 3 w.
= In older children single partially threaded cannulated screw
Early motion is strongly suggested
78. “Monteggia equivalents.”
1= Ulnar plastic deformation -17%
2= Pulled elbow syndrome
3=Both–bone forearm fractures
4=Isolated radial neck fractures
5=Dislocation of the elbow with an ulnar diaphyseal fracture
79. 8-17% of Monteggia # have a neurapraxia of the PIN
Recovery of nerve function takes several days to 2 months after injury
80. The goal of treatment
= Correct the ulnar deformity
= Restoring ulnar length and realigning
the radiocapitellar joint.
=Reduction of the ulnar fracture often
reduces the radial head .
=It is essential to confirm maintenance
of reduction.
81. OR is necessary for unstable fractures
or when closed treatment fails.
Internal fixation of the ulna with an IM Kirshner wire may allow reduction of the radial head.
This method is better than plate fixation
85. Missed injury
= Limited elbow ROM
=Arthrosis,
=Nerve complications
Ulnar osteotomy + OR of the radial head and reconstruction of the annular ligament.