Pediatrics Case #9

CC: Elbow injuryHPI: 6 yo right-handed male

presents to the ED status post fall onto outstretched left hand. Patient states that he was running on the playground at school 1 hour ago, when he lost his balance and fell. He experienced immediate throbbing pain and subsequent swelling in the right elbow. He denies weakness or sensory changes. He denies wrist or hand pain. He denies any other injuries or LOC.

History and PhysicalVS: T: 97.5 P: 120 R: 20 BP: 100/56 O2: 98%RAMusculoskeletal: RUE: TTP over lateral condyle of distal humerus with associated contusion. No crepitus on ROM. No gross deformities. Normal median/radial/ulnar nerve exam. No TTP over forearm, wrist, hand. 2+radial. 1+ulnar.

Image

Diagnosis: Lateral Humeral Condyle Fracture

Urgent vs. Emergent Ortho ConsultEmergent if is displaced

Posterior splint in 90 degreesOrtho Treatmenta. Non-operative (40%): Non-displaced or

minimally displaced fractures (<2 mm) may be treated with simple immobilization in posterior sling or with long arm cast with forearm in neutral position and elbow flexed to 90 degrees for 3-6 weeks

b. Operative (60%): ORIF is required for moderate displacement or for complete displacement

ED Treatment

Mechanism of injury:Varus stressing on extended elbow OR axial load such

as FOOSH with force submitted through forearm to radial head, which impacts lateral condyle

Clinical Evaluation: Mild swelling over lateral humeral condyle with little to no distortion of the elbow. Crepitus may be present on ROM.

Imaging: 3 view of elbow is necessary (AP, lateral, and oblique). Varus views may be ordered to accentuate any possible displacement

Pearls

Complications:Lateral condylar overgrowth with spur

formation

Delayed union or nonunion

Angular Deformity

Neurologic Compromise: ulnar nerve palsy

Osteonecrosis

Pearls

Other Images

ReferencesKoval, K. et al. Handbook of Fractures. 4th Edition. 2010.

Northwestern University School of Medicine: Emergency Medicine Residency Orthopedic Teaching Files http://www.feinberg.northwestern.edu/emergencymed/residency/ortho-teaching/

Wheeles Ortho online textbook http://www.wheelessonline.com/

www.rch.org.au