SlideShare ist ein Scribd-Unternehmen logo
1 von 87
Downloaden Sie, um offline zu lesen
Freih Odeh Abu Hassan 
F.R.C.S.(Eng.),F.R.C.S.(Tr.&Orth) 
Professor Of Orthopaedics 
University Of Jordan 
Pearls and Pitfalls
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!!!
C 
O 
R 
I
They enter the post. portion of the lat condyle lat. to the origin of the capsule & proximal to the articular cartilage, they are end vessels
1- Normal Elbow 
Radiographic parameters 
64-81
2- Check med.& lat. Column for 
translation or comminution
3-The humeral–ulnar angle is the most accurate in determining the true 
carrying angle of the elbow.
4-Pseudofracture 
The O.C of the trochlea may be 
irregular, producing a fragmented 
appearance
5-Oblique view
Direction of displacement 
-=Post.medial # - 75% 
=Post.lateral # - 25% 
Post.lateral # are more associated with NV injury.
Principles of treatment 
1-Avoid catastrophes 
e.g Vascular lesion, C. synd. 
2-Minimize embarrassment 
e.g Cubitus varus, 
Iatrogenic N injury
Emergency Room R/
1-Simple splint in the same 
position then x-ray 
2-In limb ischaemia align # 
3-Avoid flexion 
4- Record pulse & sensation
1A- Long arm splintremove 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
اصابات المرفق عند الاطفال -Pediatric elbow injuries   - البروفيسور فريح ابوحسان - استشاري جراحة العظام
Med.column collapse 
1B
=CR and Percut. Pins ,why ? 
=Long-arm cast for 3 w 
= 77% do well without pins 
Type II fractures 
Hyperflexion
Type II , medial impaction.
CR and percut. pins 
(Cross-wires)
=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
اصابات المرفق عند الاطفال -Pediatric elbow injuries   - البروفيسور فريح ابوحسان - استشاري جراحة العظام
Traction in extended 
elbow and forearm 
supination 
1
Correct varus or 
valgus and rotation 
2
Elbow flexion + 
pressure on 
olecranon then 
forearm pronation 
3
اصابات المرفق عند الاطفال -Pediatric elbow injuries   - البروفيسور فريح ابوحسان - استشاري جراحة العظام
4
Post med 
Med Pin insertion 
5
اصابات المرفق عند الاطفال -Pediatric elbow injuries   - البروفيسور فريح ابوحسان - استشاري جراحة العظام
30-40 degree
اصابات المرفق عند الاطفال -Pediatric elbow injuries   - البروفيسور فريح ابوحسان - استشاري جراحة العظام
اصابات المرفق عند الاطفال -Pediatric elbow injuries   - البروفيسور فريح ابوحسان - استشاري جراحة العظام
1-Compound # 
2-Arterial inj 
3-Compartment synd. 
4-Absent pulse after MUA 
5-Irreducible #
Irreducible #
1-Arterial injury (5–12%) 
A pulseless but pink hand can be observed. 
Decrease flexion 
2-C.Syndrome 
3-Nerve Palsy
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.
Nerve injuries 
Loss of sensation & sweating 
= 5–19% always neurapraxias. 
= 3–6 months to resolve . 
=The anterior interosseous N
اصابات المرفق عند الاطفال -Pediatric elbow injuries   - البروفيسور فريح ابوحسان - استشاري جراحة العظام
AIN palsy
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
اصابات المرفق عند الاطفال -Pediatric elbow injuries   - البروفيسور فريح ابوحسان - استشاري جراحة العظام
after repeated MUA 
3-M.Ossificans
اصابات المرفق عند الاطفال -Pediatric elbow injuries   - البروفيسور فريح ابوحسان - استشاري جراحة العظام
اصابات المرفق عند الاطفال -Pediatric elbow injuries   - البروفيسور فريح ابوحسان - استشاري جراحة العظام
Associated with 
-Vascular inj. 
-VIC 
-OPEN # 
CR or OR + Pins
اصابات المرفق عند الاطفال -Pediatric elbow injuries   - البروفيسور فريح ابوحسان - استشاري جراحة العظام
= 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.
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.
Milch Type II 
Travels from the distal lateral humeral metaphysis above the epiphysis and exits through the trochlea.
S-IV 
S-II 
I 
II
DISPLACEMENT: (Rutherford(
Stage I 
Posterior splint vs. long arm cast 
CLOSE FOLLOW-UP 
because of high incidence of late 
displacement and eventual nonmalunion .
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
=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.
Stage I 
4w
Stage II
After 7days
Stage III
اصابات المرفق عند الاطفال -Pediatric elbow injuries   - البروفيسور فريح ابوحسان - استشاري جراحة العظام
Cubitus Varus 
Secondary to malunion 
or capitellar overgrowth
اصابات المرفق عند الاطفال -Pediatric elbow injuries   - البروفيسور فريح ابوحسان - استشاري جراحة العظام
اصابات المرفق عند الاطفال -Pediatric elbow injuries   - البروفيسور فريح ابوحسان - استشاري جراحة العظام
Non Union
AVN due to extensive dissection
اصابات المرفق عند الاطفال -Pediatric elbow injuries   - البروفيسور فريح ابوحسان - استشاري جراحة العظام
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
= Associated injuries: 
*Elbow dislocation - 50% 
*Ulnar neurapraxia.
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.
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
Fracture - dislocation
اصابات المرفق عند الاطفال -Pediatric elbow injuries   - البروفيسور فريح ابوحسان - استشاري جراحة العظام
اصابات المرفق عند الاطفال -Pediatric elbow injuries   - البروفيسور فريح ابوحسان - استشاري جراحة العظام
=1% 
= Dislocation of the radial head and 
ulnar fracture ( proximal 1/3 )
Ulnar bow sign 
Normal 
Type I Monteggia
اصابات المرفق عند الاطفال -Pediatric elbow injuries   - البروفيسور فريح ابوحسان - استشاري جراحة العظام
اصابات المرفق عند الاطفال -Pediatric elbow injuries   - البروفيسور فريح ابوحسان - استشاري جراحة العظام
Type I - Anterior dislocation, 
Type II- Posterior dislocations. 
Type III -Lateral dislocation. 
Type IV Radial + Ulnar # 
+ radial head dislocation
The most reliable method to recognize Monteggia fracture
“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
8-17% of Monteggia # have a neurapraxia of the PIN 
Recovery of nerve function takes several days to 2 months after injury
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.
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
The Kocher (posterolateral) approach 
is often utilized for open reduction of the radial head.
اصابات المرفق عند الاطفال -Pediatric elbow injuries   - البروفيسور فريح ابوحسان - استشاري جراحة العظام
اصابات المرفق عند الاطفال -Pediatric elbow injuries   - البروفيسور فريح ابوحسان - استشاري جراحة العظام
Missed injury 
= Limited elbow ROM 
=Arthrosis, 
=Nerve complications 
Ulnar osteotomy + OR of the radial head and reconstruction of the annular ligament.
Open surgical treatment 
44% obtained a functional arc of motion of 30° to 130°.
اصابات المرفق عند الاطفال -Pediatric elbow injuries   - البروفيسور فريح ابوحسان - استشاري جراحة العظام

Weitere ähnliche Inhalte

Was ist angesagt?

Fatima Al Ghaithi Case Serise March 2nd
Fatima Al Ghaithi Case Serise March  2ndFatima Al Ghaithi Case Serise March  2nd
Fatima Al Ghaithi Case Serise March 2ndEM OMSB
 
SCH- supracondylar humerus fracture in childrens
SCH- supracondylar humerus fracture in childrens SCH- supracondylar humerus fracture in childrens
SCH- supracondylar humerus fracture in childrens harshkotadia
 
Supracondylar fracture of humerus
Supracondylar fracture of humerusSupracondylar fracture of humerus
Supracondylar fracture of humerusBipulBorthakur
 
Supracondylar humerus fractures in children
Supracondylar humerus fractures in childrenSupracondylar humerus fractures in children
Supracondylar humerus fractures in childrendocortho Patel
 
Supracondylar fracture of the humerus
Supracondylar fracture of the humerusSupracondylar fracture of the humerus
Supracondylar fracture of the humerusSantosh Batajoo
 
Supracondylar fractures in_children
Supracondylar fractures in_childrenSupracondylar fractures in_children
Supracondylar fractures in_childrenAhmad Naufal
 
Distal humerus fracture and elbow dislocation
Distal humerus fracture and elbow dislocationDistal humerus fracture and elbow dislocation
Distal humerus fracture and elbow dislocationAjay Kurkote
 
Supracondylar fracture of the humerus by phaneendra akana
Supracondylar fracture of the humerus by phaneendra akanaSupracondylar fracture of the humerus by phaneendra akana
Supracondylar fracture of the humerus by phaneendra akanaMohan Phaneendra Akana
 
Final final madhu sir
Final final  madhu sirFinal final  madhu sir
Final final madhu sirvaruntandra
 
Supracondylar humeral fracture
Supracondylar humeral fractureSupracondylar humeral fracture
Supracondylar humeral fractureMinThu62
 
Supra condylar fractures
Supra condylar fracturesSupra condylar fractures
Supra condylar fracturesDrzameer
 
Supracondylar humerus fractures in children
Supracondylar humerus fractures in childrenSupracondylar humerus fractures in children
Supracondylar humerus fractures in childrenRohit Somani
 
Elbow fractures and dislocations
Elbow fractures and dislocationsElbow fractures and dislocations
Elbow fractures and dislocationsTrinity Angoni
 
Supracondylar fractures in children
Supracondylar fractures in childrenSupracondylar fractures in children
Supracondylar fractures in childrenorthoprince
 
Monteggia fracture &amp; galeazzi fracture
Monteggia fracture &amp; galeazzi fractureMonteggia fracture &amp; galeazzi fracture
Monteggia fracture &amp; galeazzi fractureBipulBorthakur
 
Fractures around elbow joint in children
Fractures around elbow joint in childrenFractures around elbow joint in children
Fractures around elbow joint in childrenDr Sharanprasad Hongal
 
Fracture lateral condyle of humurus in children
Fracture lateral condyle of humurus in childrenFracture lateral condyle of humurus in children
Fracture lateral condyle of humurus in childrenWobemo Yanthan
 

Was ist angesagt? (20)

Fatima Al Ghaithi Case Serise March 2nd
Fatima Al Ghaithi Case Serise March  2ndFatima Al Ghaithi Case Serise March  2nd
Fatima Al Ghaithi Case Serise March 2nd
 
SCH- supracondylar humerus fracture in childrens
SCH- supracondylar humerus fracture in childrens SCH- supracondylar humerus fracture in childrens
SCH- supracondylar humerus fracture in childrens
 
Supracondylar fracture of humerus
Supracondylar fracture of humerusSupracondylar fracture of humerus
Supracondylar fracture of humerus
 
Supracondylar humerus fractures in children
Supracondylar humerus fractures in childrenSupracondylar humerus fractures in children
Supracondylar humerus fractures in children
 
Supracondylar fracture of the humerus
Supracondylar fracture of the humerusSupracondylar fracture of the humerus
Supracondylar fracture of the humerus
 
Supracondylar fractures in_children
Supracondylar fractures in_childrenSupracondylar fractures in_children
Supracondylar fractures in_children
 
Distal humerus fracture and elbow dislocation
Distal humerus fracture and elbow dislocationDistal humerus fracture and elbow dislocation
Distal humerus fracture and elbow dislocation
 
Supracondylar fracture of the humerus by phaneendra akana
Supracondylar fracture of the humerus by phaneendra akanaSupracondylar fracture of the humerus by phaneendra akana
Supracondylar fracture of the humerus by phaneendra akana
 
Monteggia ppt
Monteggia pptMonteggia ppt
Monteggia ppt
 
Final final madhu sir
Final final  madhu sirFinal final  madhu sir
Final final madhu sir
 
Supracondylar humeral fracture
Supracondylar humeral fractureSupracondylar humeral fracture
Supracondylar humeral fracture
 
Supra condylar fractures
Supra condylar fracturesSupra condylar fractures
Supra condylar fractures
 
Supracondylar humerus fractures in children
Supracondylar humerus fractures in childrenSupracondylar humerus fractures in children
Supracondylar humerus fractures in children
 
Elbow fractures and dislocations
Elbow fractures and dislocationsElbow fractures and dislocations
Elbow fractures and dislocations
 
Supracondylar Fractures
Supracondylar FracturesSupracondylar Fractures
Supracondylar Fractures
 
Supracondylar fractures in children
Supracondylar fractures in childrenSupracondylar fractures in children
Supracondylar fractures in children
 
Monteggia fracture &amp; galeazzi fracture
Monteggia fracture &amp; galeazzi fractureMonteggia fracture &amp; galeazzi fracture
Monteggia fracture &amp; galeazzi fracture
 
Fractures around elbow joint in children
Fractures around elbow joint in childrenFractures around elbow joint in children
Fractures around elbow joint in children
 
Fracture lateral condyle of humurus in children
Fracture lateral condyle of humurus in childrenFracture lateral condyle of humurus in children
Fracture lateral condyle of humurus in children
 
Supracondylar humerus and pink pulseless extremity
Supracondylar humerus and pink pulseless extremitySupracondylar humerus and pink pulseless extremity
Supracondylar humerus and pink pulseless extremity
 

Andere mochten auch

Elbow trauma & infection
Elbow trauma & infectionElbow trauma & infection
Elbow trauma & infectionmrinal joshi
 
Emergency medicine board review
Emergency medicine board reviewEmergency medicine board review
Emergency medicine board reviewtfalgiani
 
Kin 191 B – Elbow And Forearm Pathologies
Kin 191 B – Elbow And Forearm PathologiesKin 191 B – Elbow And Forearm Pathologies
Kin 191 B – Elbow And Forearm PathologiesJLS10
 
supracondylar fracrture of humerus in children
supracondylar fracrture of humerus in childrensupracondylar fracrture of humerus in children
supracondylar fracrture of humerus in childrenHardik Pawar
 
Do it-yourself-paeds-ortho (Paediatric Orthopaedics for beginners)
Do it-yourself-paeds-ortho (Paediatric Orthopaedics for beginners)Do it-yourself-paeds-ortho (Paediatric Orthopaedics for beginners)
Do it-yourself-paeds-ortho (Paediatric Orthopaedics for beginners)Jonathan Cheah
 
P05 pediatric elbow
P05 pediatric elbowP05 pediatric elbow
P05 pediatric elbowClaudiu Cucu
 
Elbow Rajat Mathur
Elbow Rajat MathurElbow Rajat Mathur
Elbow Rajat Mathurrickyrajat
 
Sports%20 medicine[1]
Sports%20 medicine[1]Sports%20 medicine[1]
Sports%20 medicine[1]mtsegui
 
#العلاج_الطبيعي - لمحة تعريفية عن التخصص
#العلاج_الطبيعي - لمحة تعريفية عن التخصص#العلاج_الطبيعي - لمحة تعريفية عن التخصص
#العلاج_الطبيعي - لمحة تعريفية عن التخصصPTideas
 
4. humerus fractures
4. humerus fractures4. humerus fractures
4. humerus fracturesFahad Zakwan
 
Common ped problem_2014
Common ped problem_2014Common ped problem_2014
Common ped problem_2014Ahmed-shedeed
 
Paediatric forearm fractures
Paediatric forearm fracturesPaediatric forearm fractures
Paediatric forearm fracturesHiren Divecha
 

Andere mochten auch (20)

Neonatal Brachial Plexus injury- البروفيسور فريح ابوحسان - استشاري جراحة العظ...
Neonatal Brachial Plexus injury- البروفيسور فريح ابوحسان - استشاري جراحة العظ...Neonatal Brachial Plexus injury- البروفيسور فريح ابوحسان - استشاري جراحة العظ...
Neonatal Brachial Plexus injury- البروفيسور فريح ابوحسان - استشاري جراحة العظ...
 
5 pediatric #
5 pediatric #5 pediatric #
5 pediatric #
 
Elbow Pain
Elbow PainElbow Pain
Elbow Pain
 
Pulled elbow
Pulled elbowPulled elbow
Pulled elbow
 
Elbow trauma & infection
Elbow trauma & infectionElbow trauma & infection
Elbow trauma & infection
 
Emergency medicine board review
Emergency medicine board reviewEmergency medicine board review
Emergency medicine board review
 
Kin 191 B – Elbow And Forearm Pathologies
Kin 191 B – Elbow And Forearm PathologiesKin 191 B – Elbow And Forearm Pathologies
Kin 191 B – Elbow And Forearm Pathologies
 
Congenital upper limb البروفيسور فريح ابوحسان - استشاري جراحة العظام في الاردن
Congenital upper limb  البروفيسور فريح ابوحسان - استشاري جراحة العظام في الاردنCongenital upper limb  البروفيسور فريح ابوحسان - استشاري جراحة العظام في الاردن
Congenital upper limb البروفيسور فريح ابوحسان - استشاري جراحة العظام في الاردن
 
supracondylar fracrture of humerus in children
supracondylar fracrture of humerus in childrensupracondylar fracrture of humerus in children
supracondylar fracrture of humerus in children
 
Do it-yourself-paeds-ortho (Paediatric Orthopaedics for beginners)
Do it-yourself-paeds-ortho (Paediatric Orthopaedics for beginners)Do it-yourself-paeds-ortho (Paediatric Orthopaedics for beginners)
Do it-yourself-paeds-ortho (Paediatric Orthopaedics for beginners)
 
P05 pediatric elbow
P05 pediatric elbowP05 pediatric elbow
P05 pediatric elbow
 
Elbow Rajat Mathur
Elbow Rajat MathurElbow Rajat Mathur
Elbow Rajat Mathur
 
Sports%20 medicine[1]
Sports%20 medicine[1]Sports%20 medicine[1]
Sports%20 medicine[1]
 
#العلاج_الطبيعي - لمحة تعريفية عن التخصص
#العلاج_الطبيعي - لمحة تعريفية عن التخصص#العلاج_الطبيعي - لمحة تعريفية عن التخصص
#العلاج_الطبيعي - لمحة تعريفية عن التخصص
 
4. humerus fractures
4. humerus fractures4. humerus fractures
4. humerus fractures
 
امراض العضلات عند الاطفال- Pediatric Muscle dystrophy- - البروفيسور فريح ابو...
امراض العضلات عند الاطفال- Pediatric Muscle dystrophy-  - البروفيسور فريح ابو...امراض العضلات عند الاطفال- Pediatric Muscle dystrophy-  - البروفيسور فريح ابو...
امراض العضلات عند الاطفال- Pediatric Muscle dystrophy- - البروفيسور فريح ابو...
 
امراض مفصل الورك عند الاطفال- Pediatric hip البروفيسور فريح ابوحسان
امراض مفصل الورك عند الاطفال- Pediatric hip   البروفيسور فريح ابوحسان  امراض مفصل الورك عند الاطفال- Pediatric hip   البروفيسور فريح ابوحسان
امراض مفصل الورك عند الاطفال- Pediatric hip البروفيسور فريح ابوحسان
 
Common ped problem_2014
Common ped problem_2014Common ped problem_2014
Common ped problem_2014
 
Paediatric forearm fractures
Paediatric forearm fracturesPaediatric forearm fractures
Paediatric forearm fractures
 
اضطرابات الاطراف السفليه عند الاطفال - Pediatric lower limb disorders الب...
 اضطرابات الاطراف السفليه عند الاطفال -  Pediatric lower limb disorders   الب... اضطرابات الاطراف السفليه عند الاطفال -  Pediatric lower limb disorders   الب...
اضطرابات الاطراف السفليه عند الاطفال - Pediatric lower limb disorders الب...
 

Ähnlich wie اصابات المرفق عند الاطفال -Pediatric elbow injuries - البروفيسور فريح ابوحسان - استشاري جراحة العظام

D) supracondylar fracture
D) supracondylar fractureD) supracondylar fracture
D) supracondylar fracturevaruntandra
 
Distal humerus fracture in pediatrics by dr ashutosh
Distal humerus fracture in pediatrics by dr ashutoshDistal humerus fracture in pediatrics by dr ashutosh
Distal humerus fracture in pediatrics by dr ashutoshAshutosh Kumar
 
Proximal humerus fractures
Proximal humerus fracturesProximal humerus fractures
Proximal humerus fracturesorthoprince
 
Monteggia fracture dislocation in chldren
Monteggia fracture dislocation in chldrenMonteggia fracture dislocation in chldren
Monteggia fracture dislocation in chldrenHamid Hejrati
 
Lateral condyle of humerus fracture in children
Lateral condyle of humerus fracture in childrenLateral condyle of humerus fracture in children
Lateral condyle of humerus fracture in childrenAnilKC5
 
pinal cord injury.ppt
pinal cord injury.pptpinal cord injury.ppt
pinal cord injury.pptAsgraf
 
ELBOW_FRACTURE& Supracondylar fracture .ppt
ELBOW_FRACTURE& Supracondylar fracture .pptELBOW_FRACTURE& Supracondylar fracture .ppt
ELBOW_FRACTURE& Supracondylar fracture .pptRajveerYadav40
 
anatomy of elbow & fractures around elbow & surgical options in adults
anatomy of elbow & fractures around elbow & surgical options in adultsanatomy of elbow & fractures around elbow & surgical options in adults
anatomy of elbow & fractures around elbow & surgical options in adultsdocortho Patel
 
Clavicle fracture
Clavicle fractureClavicle fracture
Clavicle fractureHarshita89
 
Fracture & dislocation around the elbow
Fracture & dislocation  around the elbow Fracture & dislocation  around the elbow
Fracture & dislocation around the elbow MONTHER ALKHAWLANY
 
Conference ext.สิทธิกร ปภาวิน orthokorat 1
Conference ext.สิทธิกร ปภาวิน orthokorat 1Conference ext.สิทธิกร ปภาวิน orthokorat 1
Conference ext.สิทธิกร ปภาวิน orthokorat 1sittikornpaphawin
 
Classificaton-of-injuries-around-elbow-management-of-supracondylar-fracture-d...
Classificaton-of-injuries-around-elbow-management-of-supracondylar-fracture-d...Classificaton-of-injuries-around-elbow-management-of-supracondylar-fracture-d...
Classificaton-of-injuries-around-elbow-management-of-supracondylar-fracture-d...RAdhavan
 
C2 (Axis) cervical Spine Fracture Presentation
C2 (Axis) cervical Spine Fracture PresentationC2 (Axis) cervical Spine Fracture Presentation
C2 (Axis) cervical Spine Fracture PresentationAnas Ahmed
 
Fracture of shaft and distal part of Femoral bone by Dr. Ammar Alsabae
Fracture of shaft and distal part  of Femoral bone by Dr. Ammar AlsabaeFracture of shaft and distal part  of Femoral bone by Dr. Ammar Alsabae
Fracture of shaft and distal part of Femoral bone by Dr. Ammar AlsabaeAmmar Alsbae
 
Elbow instability
Elbow instabilityElbow instability
Elbow instabilityAyush Arora
 

Ähnlich wie اصابات المرفق عند الاطفال -Pediatric elbow injuries - البروفيسور فريح ابوحسان - استشاري جراحة العظام (20)

D) supracondylar fracture
D) supracondylar fractureD) supracondylar fracture
D) supracondylar fracture
 
Distal humerus fracture in pediatrics by dr ashutosh
Distal humerus fracture in pediatrics by dr ashutoshDistal humerus fracture in pediatrics by dr ashutosh
Distal humerus fracture in pediatrics by dr ashutosh
 
Proximal humerus fractures
Proximal humerus fracturesProximal humerus fractures
Proximal humerus fractures
 
humerus fracture
humerus fracturehumerus fracture
humerus fracture
 
spinal cord injury
 spinal cord injury spinal cord injury
spinal cord injury
 
Monteggia fracture dislocation in chldren
Monteggia fracture dislocation in chldrenMonteggia fracture dislocation in chldren
Monteggia fracture dislocation in chldren
 
Lateral condyle of humerus fracture in children
Lateral condyle of humerus fracture in childrenLateral condyle of humerus fracture in children
Lateral condyle of humerus fracture in children
 
pinal cord injury.ppt
pinal cord injury.pptpinal cord injury.ppt
pinal cord injury.ppt
 
ELBOW_FRACTURE& Supracondylar fracture .ppt
ELBOW_FRACTURE& Supracondylar fracture .pptELBOW_FRACTURE& Supracondylar fracture .ppt
ELBOW_FRACTURE& Supracondylar fracture .ppt
 
anatomy of elbow & fractures around elbow & surgical options in adults
anatomy of elbow & fractures around elbow & surgical options in adultsanatomy of elbow & fractures around elbow & surgical options in adults
anatomy of elbow & fractures around elbow & surgical options in adults
 
Clavicle fracture
Clavicle fractureClavicle fracture
Clavicle fracture
 
Fracture & dislocation around the elbow
Fracture & dislocation  around the elbow Fracture & dislocation  around the elbow
Fracture & dislocation around the elbow
 
Elbow FRACTURE
Elbow FRACTUREElbow FRACTURE
Elbow FRACTURE
 
Conference ext.สิทธิกร ปภาวิน orthokorat 1
Conference ext.สิทธิกร ปภาวิน orthokorat 1Conference ext.สิทธิกร ปภาวิน orthokorat 1
Conference ext.สิทธิกร ปภาวิน orthokorat 1
 
Classificaton-of-injuries-around-elbow-management-of-supracondylar-fracture-d...
Classificaton-of-injuries-around-elbow-management-of-supracondylar-fracture-d...Classificaton-of-injuries-around-elbow-management-of-supracondylar-fracture-d...
Classificaton-of-injuries-around-elbow-management-of-supracondylar-fracture-d...
 
C2 (Axis) cervical Spine Fracture Presentation
C2 (Axis) cervical Spine Fracture PresentationC2 (Axis) cervical Spine Fracture Presentation
C2 (Axis) cervical Spine Fracture Presentation
 
C1 C2 fractures
C1 C2 fracturesC1 C2 fractures
C1 C2 fractures
 
Fracture clavicle
Fracture clavicleFracture clavicle
Fracture clavicle
 
Fracture of shaft and distal part of Femoral bone by Dr. Ammar Alsabae
Fracture of shaft and distal part  of Femoral bone by Dr. Ammar AlsabaeFracture of shaft and distal part  of Femoral bone by Dr. Ammar Alsabae
Fracture of shaft and distal part of Femoral bone by Dr. Ammar Alsabae
 
Elbow instability
Elbow instabilityElbow instability
Elbow instability
 

Mehr von Prof Freih Abu Hassan البروفيسور فريح ابوحسان

Mehr von Prof Freih Abu Hassan البروفيسور فريح ابوحسان (20)

Use_of_zoledronic_acid_in_pelvic_and_sacral.2.pdf
Use_of_zoledronic_acid_in_pelvic_and_sacral.2.pdfUse_of_zoledronic_acid_in_pelvic_and_sacral.2.pdf
Use_of_zoledronic_acid_in_pelvic_and_sacral.2.pdf
 
Unusual_Osteoblastoma_of_the_First_Metatarsal_Bone..pdf
Unusual_Osteoblastoma_of_the_First_Metatarsal_Bone..pdfUnusual_Osteoblastoma_of_the_First_Metatarsal_Bone..pdf
Unusual_Osteoblastoma_of_the_First_Metatarsal_Bone..pdf
 
Treatment of Aneurysmal Bone Cysts by Minimally Invasive Curettage and Alloge...
Treatment of Aneurysmal Bone Cysts by Minimally Invasive Curettage and Alloge...Treatment of Aneurysmal Bone Cysts by Minimally Invasive Curettage and Alloge...
Treatment of Aneurysmal Bone Cysts by Minimally Invasive Curettage and Alloge...
 
short-versus-long-leg-hip-spica-after-closed-reduction-in-de.pdf
short-versus-long-leg-hip-spica-after-closed-reduction-in-de.pdfshort-versus-long-leg-hip-spica-after-closed-reduction-in-de.pdf
short-versus-long-leg-hip-spica-after-closed-reduction-in-de.pdf
 
Percutaneous Curettage and Local Autologous Cancellous Bone Graft A Simple an...
Percutaneous Curettage and Local Autologous Cancellous Bone Graft A Simple an...Percutaneous Curettage and Local Autologous Cancellous Bone Graft A Simple an...
Percutaneous Curettage and Local Autologous Cancellous Bone Graft A Simple an...
 
Lower Limb Reconstruction Using Tibial Strut.pdf
Lower Limb Reconstruction Using Tibial Strut.pdfLower Limb Reconstruction Using Tibial Strut.pdf
Lower Limb Reconstruction Using Tibial Strut.pdf
 
Femoral_Reconstruction_Using_Long_Tibial_Autograft.24.pdf
Femoral_Reconstruction_Using_Long_Tibial_Autograft.24.pdfFemoral_Reconstruction_Using_Long_Tibial_Autograft.24.pdf
Femoral_Reconstruction_Using_Long_Tibial_Autograft.24.pdf
 
Treatment of Aneurysmal Bone Cysts by Minimally Invasive Curettage and Alloge...
Treatment of Aneurysmal Bone Cysts by Minimally Invasive Curettage and Alloge...Treatment of Aneurysmal Bone Cysts by Minimally Invasive Curettage and Alloge...
Treatment of Aneurysmal Bone Cysts by Minimally Invasive Curettage and Alloge...
 
Tuberculous dactylitis pseudotumor of an adult thumb.pdf
Tuberculous dactylitis pseudotumor of an adult thumb.pdfTuberculous dactylitis pseudotumor of an adult thumb.pdf
Tuberculous dactylitis pseudotumor of an adult thumb.pdf
 
Subperiosteal resection of mid-clavicle in sprengel's.pdf
Subperiosteal resection of mid-clavicle in sprengel's.pdfSubperiosteal resection of mid-clavicle in sprengel's.pdf
Subperiosteal resection of mid-clavicle in sprengel's.pdf
 
Subperiosteal resection of aneurysmal bone .pdf
Subperiosteal resection of aneurysmal bone .pdfSubperiosteal resection of aneurysmal bone .pdf
Subperiosteal resection of aneurysmal bone .pdf
 
Safety and Efficacy of Autologous Intra-articular Platelet.pdf
Safety and Efficacy of Autologous Intra-articular Platelet.pdfSafety and Efficacy of Autologous Intra-articular Platelet.pdf
Safety and Efficacy of Autologous Intra-articular Platelet.pdf
 
Outcome of Percutaneous Curettage, Local Autologous Cancellous Bone Graft for...
Outcome of Percutaneous Curettage, Local Autologous Cancellous Bone Graft for...Outcome of Percutaneous Curettage, Local Autologous Cancellous Bone Graft for...
Outcome of Percutaneous Curettage, Local Autologous Cancellous Bone Graft for...
 
Non-vascularized fibular graft reconstruction after resection.pdf
Non-vascularized fibular graft reconstruction after resection.pdfNon-vascularized fibular graft reconstruction after resection.pdf
Non-vascularized fibular graft reconstruction after resection.pdf
 
Birth associated long bone fractures.pdf.pdf
Birth associated long bone fractures.pdf.pdfBirth associated long bone fractures.pdf.pdf
Birth associated long bone fractures.pdf.pdf
 
Complete subtalar release for older children.pdf
Complete subtalar release for older children.pdfComplete subtalar release for older children.pdf
Complete subtalar release for older children.pdf
 
Associated Risk Factors in Middle Eatern Patients who had Primary Knee Osteoa...
Associated Risk Factors in Middle Eatern Patients who had Primary Knee Osteoa...Associated Risk Factors in Middle Eatern Patients who had Primary Knee Osteoa...
Associated Risk Factors in Middle Eatern Patients who had Primary Knee Osteoa...
 
Percutaneous fenestration.pdf
Percutaneous fenestration.pdfPercutaneous fenestration.pdf
Percutaneous fenestration.pdf
 
Intramuscular myxoma of the hypothenar muscles.pdf
Intramuscular myxoma of the hypothenar muscles.pdfIntramuscular myxoma of the hypothenar muscles.pdf
Intramuscular myxoma of the hypothenar muscles.pdf
 
Hand dominance and gender in forearm fractures in children.pdf
Hand dominance and gender in forearm fractures in children.pdfHand dominance and gender in forearm fractures in children.pdf
Hand dominance and gender in forearm fractures in children.pdf
 

Kürzlich hochgeladen

CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.pptRamDBawankar1
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu Medical University
 
Physiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid ArthritisPhysiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid ArthritisNilofarRasheed1
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu Medical University
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptxWINCY THIRUMURUGAN
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.aarjukhadka22
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE Mamatha Lakka
 
Microbiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxMicrobiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxkitati1
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfHongBiThi1
 
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptxGood Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptxLikeways
 
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...Ganesan Yogananthem
 
World-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxWorld-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxsumanchaulagain3
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptPradnya Wadekar
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxMAsifAhmad
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 

Kürzlich hochgeladen (20)

CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu
 
Physiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid ArthritisPhysiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid Arthritis
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE
 
Microbiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxMicrobiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptx
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
 
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptxGood Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptx
 
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
 
World-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxWorld-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptx
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologyppt
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 

اصابات المرفق عند الاطفال -Pediatric elbow injuries - البروفيسور فريح ابوحسان - استشاري جراحة العظام

  • 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!!!
  • 3. C O R I
  • 4. They enter the post. portion of the lat condyle lat. to the origin of the capsule & proximal to the articular cartilage, they are end vessels
  • 5. 1- Normal Elbow Radiographic parameters 64-81
  • 6. 2- Check med.& lat. Column for translation or comminution
  • 7. 3-The humeral–ulnar angle is the most accurate in determining the true carrying angle of the elbow.
  • 8. 4-Pseudofracture The O.C of the trochlea may be irregular, producing a fragmented appearance
  • 10. Direction of displacement -=Post.medial # - 75% =Post.lateral # - 25% Post.lateral # are more associated with NV injury.
  • 11. Principles of treatment 1-Avoid catastrophes e.g Vascular lesion, C. synd. 2-Minimize embarrassment e.g Cubitus varus, Iatrogenic N injury
  • 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 splintremove 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
  • 17. =CR and Percut. Pins ,why ? =Long-arm cast for 3 w = 77% do well without pins Type II fractures Hyperflexion
  • 18. Type II , medial impaction.
  • 19. CR and percut. pins (Cross-wires)
  • 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
  • 22. Traction in extended elbow and forearm supination 1
  • 23. Correct varus or valgus and rotation 2
  • 24. Elbow flexion + pressure on olecranon then forearm pronation 3
  • 26. 4
  • 27. Post med Med Pin insertion 5
  • 32. 1-Compound # 2-Arterial inj 3-Compartment synd. 4-Absent pulse after MUA 5-Irreducible #
  • 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
  • 41. after repeated MUA 3-M.Ossificans
  • 44. Associated with -Vascular inj. -VIC -OPEN # CR or OR + Pins
  • 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.
  • 59. Cubitus Varus Secondary to malunion or capitellar overgrowth
  • 63. AVN due to extensive dissection
  • 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
  • 66. = Associated injuries: *Elbow dislocation - 50% *Ulnar neurapraxia.
  • 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
  • 72. =1% = Dislocation of the radial head and ulnar fracture ( proximal 1/3 )
  • 73. Ulnar bow sign Normal Type I Monteggia
  • 76. Type I - Anterior dislocation, Type II- Posterior dislocations. Type III -Lateral dislocation. Type IV Radial + Ulnar # + radial head dislocation
  • 77. The most reliable method to recognize Monteggia fracture
  • 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
  • 82. The Kocher (posterolateral) approach is often utilized for open reduction of the radial head.
  • 85. Missed injury = Limited elbow ROM =Arthrosis, =Nerve complications Ulnar osteotomy + OR of the radial head and reconstruction of the annular ligament.
  • 86. Open surgical treatment 44% obtained a functional arc of motion of 30° to 130°.