ü Mechanism of Injury- fall on the outstretched hand with elbow in full extension
ü Types:-1) Extension type (97%)
2) Flexion type (3%)
ü Rt > Lt
ü
ü Commoner in boys aged 5-8 yrs(♂:♀::3:2)
ü Vascular Injury-1%
ü VIC- 0.5% of fractures
ü Nerve Involvement-Radial (41%)>Median (36%) >Ulnar (23%)
ü Modified GARTLAND Classification- Type I- Undisplaced
-Type II- Intact posterior cortex- hinged posteriorly
- Type III- Displaced- no cortical contact.
-Type IV- displaces into Extension & Flexion
-Medial Comminution- collapse of medial column
ü Displacement into- flexion
-extension
-Posteromedially
-Posterolaterally
-Coronal Tilting
ü Clinical Evaluation-
a. History of Fall
b. Signs & Symptoms- Pain, Swelling, Movement-restriction, Pucker Sign; Neurovascular Status
ü Radiographic Evaluation:-
(i) AP view- 1. Bowman Angle- shaft-physeal angle
2. Humeral-Ulnar Angle- the most accurate in determining true carrying angle,
3. Metaphyseal-diaphyseal angle- least accurate of the three.
(ii) Lateral View- 1. Tear drop
2. Shaft-Condylar Angle: 40o
3. Anterior Humeral Line
4. Coronoid Line
5. Fat Pad Sign- esp. posterior fat pad sign-may be the only sign in some cases
6. Crescent Sign
(iii) Jones view- when extension of elbow difficult
- If not clear→ internal & external oblique views
ü MANAGEMENT :-
a) Type I #- long-arm cast with 60-90o of elbow flexion for ~3 wks.
b) Type II # -Closed reduction & Percutaneous Pinning(1st choice)
-Closed reduction & casting
c) Type III #- Closed Reduction & percutaneous pinning
d) Type IV #- Open Reduction & Fixation with K-wires
ü COMPLICATIONS :-
1) Vascular Injury
2) Compartment Syndrome
3) Neurologic Deficit
4) Elbow Stiffness
5) Pin Track Infection
6) Myositis Ossificans
7) Loss of Reduction
8) Hyperextension
9) Cubitus Varus
10) Osteonecrosis of Trochlea
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