Conference ext.อิศรา เย็นยุวดี (เต้ย รพ.รามา)

CASE CONFERENCE

EXT. อิศรา เยน็ยุวดีรพ.รามาธบิดี

Patient profileเด็กหญิงไทย อายุ 6 ปีChief complaint ล้มเจบ็ขอ้ศอกขวา 5ชม.ก่อนมา

รพ.

o 5 ชม.PTA ล้มศอกขวากระแทกพื้น

o ศีรษะไมก่ระแทก ไมส่ลบo มอีาการเจบ็ที่ขอ้ศอกขวาทันที ขยบั

ไมไ่ด้ ขอ้ศอกบวม ขยบันิ้วมอืได้ ไมม่บีาดแผลท่ีใด

Primary surveyA : Can speak, no tender along

neck, full ROM of neckB : Trachea in midline, normal

breath sound, equal both lungsC : BP 100/72 mmHg PR 100/min

RR 22/min T 36.5°CD : E4 V5 M6 E : swelling and pain at Rt. elbow,

no wound, no bleeding

Secondary surveyAllergy : noneMedication : nonePast history : normal labor,

normal growth and developmentLast meal : 16.30 น. Event/Environment : เวลา17.00น.

ล้ม ศอกขวากระแทกพื้น ไมม่บีาดแผลท่ีใด เจบ็ศอกขวาทันที มแีขนบวม ขยบันิ้วมอืได้

Physical examination Swelling with ecchymosis at lateral side Rt.

Elbow No bleeding or open wound Limit active movement of Rt. elbow due to

pain Tender lateral side of right elbow, no

crepitation, with no prominent bone Loss of isocele triangle Right elbow

radial pules 2+, capillary refill 2 sec

Median n.-> flexor group : intact

Ulnar n.-> intrinsic m. of hand :intact

Radial n.-> extensor group :intact

Sensory :intact

Neurovascular aspect:

Problem list

1.Sudden Right elbow pain with swelling

Differential diagnosis

Supracondylar fracture Rt.

Lateral condyle fracturePost. Elbow dislocation

Investigation

Film Rt. Elbow AP, Lateral

Lateral condyle fracture

Diagnosis

Lateral condyle fractureAbout 15% of elbow fracturefractures Injury mechanism

Pull off type-Varus stress to extended elbow and supinated forearm Push off type-valgus force by radial head directly to the lateral

condyle

Milch classification Type I Type II; unstable Salter Harris classification Type II vs. Type IV Classification according to displacement

(JAKOB) Non-displaced; less than 2 mm Minimally displaced: 2 ~4 mm Displaced: grater than 4 mm

Milch classification

Classification according to displacement

Stable non-displaced fracture close follow-up (1, 2, 4 weeks) cast (radiographic healing: 6 weeks)

Potentially unstable, minimally displaced fracture: C/R or open reduction & fixation

Displaced: Open reduction & Pin Late presenting (2 to 12 weeks)

controversial REFER

Treatment

ORIF with K-wire at right elbowPosterior long arm slab on right arm

John, JBJS. 84A:2079~2089 Milsky, J Orthop Trauma. 1997;11:117~120