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Paediatric biepicondylar elbow fracture dislocation - a case report.

Meta M, Miller D - J Orthop Surg Res (2010)

Bottom Line: Paediatric elbow biepicondylar fracture dislocations are very rare injuries and have been only published in two independent case reviews.We report a case of 13 years old boy, who sustained this unusual injury after a fall on outstretched hand resulting in an unstable elbow fracture dislocation.This type of injury needs operative treatment and fixation to restore stability and return to normal or near normal elbow function.

View Article: PubMed Central - HTML - PubMed

Affiliation: Orthopaedic Registrar , Department of Orthopaedics, Royal Brisbane & Women Hospital, Butterfield Street, Herston 4029, QLD Australia. meta_orthouk@yahoo.co.uk.

ABSTRACT
Paediatric elbow biepicondylar fracture dislocations are very rare injuries and have been only published in two independent case reviews. We report a case of 13 years old boy, who sustained this unusual injury after a fall on outstretched hand resulting in an unstable elbow fracture dislocation. Closed reduction was performed followed by delayed ORIF (Open Reduction and Internal Fixation) with K wires. Final follow-up at 14 weeks revealed a stable elbow and satisfactory function with full supination-pronation, range of motion from 0°-120° of flexion and normal muscle strength. This type of injury needs operative treatment and fixation to restore stability and return to normal or near normal elbow function. The method of fixation (screws or K wires) may depend on size and number of fracture fragments.

No MeSH data available.


Related in: MedlinePlus

Injury X-ray 1 (showing dislocated elbow with biepicondylar fractures).
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Figure 1: Injury X-ray 1 (showing dislocated elbow with biepicondylar fractures).

Mentions: A 13 yrs old boy sustained a fall on his outstretched hand. He presented with a grossly swollen and deformed elbow. Radiographs demonstrated a posterolateral elbow dislocation with fractures of both the lateral and medial epicondyles (Figures 1 and 2 - showing three different views). The elbow dislocation was reduced and immobilized in the emergency department. Post-reduction radiographs showed a reduced elbow with displaced fractures of medial and lateral epicondyles (Figure 3- Post reduction radiographs demonstrating AP and Lateral views). However as the elbow remained clinically highly unstable and the fractures were still markedly displaced, operative intervention was deemed necessary. ORIF of both the medial and lateral epicondyles was performed using a separate medial and lateral approach. Due to the presence of fracture comminution and small sized fragments of both epicondyles, screw fixation was deferred. K wire fixation using two 1.6 mm wires for each the lateral and medial epicondyle was preferred. Post-operative radiographs showed satisfactory reduction and fixation (Figure 4- postoperative radiographs showing AP and lateral views after K wire fixation). Following six weeks of immobilization in a plaster of Paris, active elbow ROM (range of motion) was commenced by a physiotherapist. The patient received weekly physiotherapist treatment until week 14. K wires were removed at postoperative week eight. At the final follow-up 14 weeks postoperatively, satisfactory elbow function (0°-120° flexion, full supination and pronation, with normal strength and stable elbow) was observed. Radiographs demonstrated bony union and no evidence of myositis ossificans (Figure 5- Final follow up radiographs showing AP and lateral views of elbow with union of both epicondyles). Prophylactic treatment for myositis ossificans was not used.


Paediatric biepicondylar elbow fracture dislocation - a case report.

Meta M, Miller D - J Orthop Surg Res (2010)

Injury X-ray 1 (showing dislocated elbow with biepicondylar fractures).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2965708&req=5

Figure 1: Injury X-ray 1 (showing dislocated elbow with biepicondylar fractures).
Mentions: A 13 yrs old boy sustained a fall on his outstretched hand. He presented with a grossly swollen and deformed elbow. Radiographs demonstrated a posterolateral elbow dislocation with fractures of both the lateral and medial epicondyles (Figures 1 and 2 - showing three different views). The elbow dislocation was reduced and immobilized in the emergency department. Post-reduction radiographs showed a reduced elbow with displaced fractures of medial and lateral epicondyles (Figure 3- Post reduction radiographs demonstrating AP and Lateral views). However as the elbow remained clinically highly unstable and the fractures were still markedly displaced, operative intervention was deemed necessary. ORIF of both the medial and lateral epicondyles was performed using a separate medial and lateral approach. Due to the presence of fracture comminution and small sized fragments of both epicondyles, screw fixation was deferred. K wire fixation using two 1.6 mm wires for each the lateral and medial epicondyle was preferred. Post-operative radiographs showed satisfactory reduction and fixation (Figure 4- postoperative radiographs showing AP and lateral views after K wire fixation). Following six weeks of immobilization in a plaster of Paris, active elbow ROM (range of motion) was commenced by a physiotherapist. The patient received weekly physiotherapist treatment until week 14. K wires were removed at postoperative week eight. At the final follow-up 14 weeks postoperatively, satisfactory elbow function (0°-120° flexion, full supination and pronation, with normal strength and stable elbow) was observed. Radiographs demonstrated bony union and no evidence of myositis ossificans (Figure 5- Final follow up radiographs showing AP and lateral views of elbow with union of both epicondyles). Prophylactic treatment for myositis ossificans was not used.

Bottom Line: Paediatric elbow biepicondylar fracture dislocations are very rare injuries and have been only published in two independent case reviews.We report a case of 13 years old boy, who sustained this unusual injury after a fall on outstretched hand resulting in an unstable elbow fracture dislocation.This type of injury needs operative treatment and fixation to restore stability and return to normal or near normal elbow function.

View Article: PubMed Central - HTML - PubMed

Affiliation: Orthopaedic Registrar , Department of Orthopaedics, Royal Brisbane & Women Hospital, Butterfield Street, Herston 4029, QLD Australia. meta_orthouk@yahoo.co.uk.

ABSTRACT
Paediatric elbow biepicondylar fracture dislocations are very rare injuries and have been only published in two independent case reviews. We report a case of 13 years old boy, who sustained this unusual injury after a fall on outstretched hand resulting in an unstable elbow fracture dislocation. Closed reduction was performed followed by delayed ORIF (Open Reduction and Internal Fixation) with K wires. Final follow-up at 14 weeks revealed a stable elbow and satisfactory function with full supination-pronation, range of motion from 0°-120° of flexion and normal muscle strength. This type of injury needs operative treatment and fixation to restore stability and return to normal or near normal elbow function. The method of fixation (screws or K wires) may depend on size and number of fracture fragments.

No MeSH data available.


Related in: MedlinePlus