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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