lateral condyle fractures in children

Thinking smart in the management of Lateral condyle fractures in children:

Thinking smart in the management of Lateral condyle fractures in children Taral Nagda Hinduja Saifee Parel Jupiter www.IPODindia.org

Slide 2:

Tip 1 Radio Capitellar line Passes thro center of capitellum in any position of elbow, any view of elbow

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Radio Capitellar line Passes thro center of capitellum in any position of elbow, any view of elbow RCL maintained in displased SCF

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Disturbed Elbow dislocation Lateral condyle Radial dislocation Maintained Physeal separation Supracondylar

Tip 2 Know the Ossification Centres:

Tip 2 Know the Ossification Centres

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European study C- Capitulum , (3 months) R- Radial head, (5 years) I- Internal (medial) epicondyle , (7 years) T- Trochlea , (9 years) O- Olecranon , (11 years) E- External or Lateral epicondyle , (13 years) Chinese study C- Capitulum , (1 year) R- Radial head, (5 years) I- Internal (medial) epicondyle ), (5 years) O- Olecranon , (9 years) T- Trochlea , (9years) E- External or lateral epicondyle , (10years) Newborn 3 years 5 years 9 years

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C apitellum 1 R adial Head 3 I nt Epi 5 T rochlea 7 E xt Epi 11 O lecranon 9 Come Ride My Train Of Love

Tip 2 Take xray in internal rotation When in doubt take xray of opposite elbow:

Tip 2 Take xray in internal rotation When in doubt take xray of opposite elbow

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Internal oblique view shows presence and displacement of lateral condyle fracture better

Tip 3 Visualisation of unseen physis:

Tip 3 Visualisation of unseen physis Arthrogram MRI Ultrasound

Arthrogram to show lateral condyle fracture:

Arthrogram to show lateral condyle fracture Case Courtsey Dr Sandeep Patwardhan Pune

MRI to differenciate bet stage 1a and 1b lateral condyle fractures:

A B MRI to differenciate bet stage 1a and 1b lateral condyle fractures

Classification: Jacob:

Classification: Jacob Stage 1 Stage 2 Stage 3

Stage 1 injuries:

Stage 1 injuries

Story of 6 year old with elbow injury:

Story of 6 year old with elbow injury

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At 4wks

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7 yrs. later Fracture of necessity

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Do we need to pin all undisplased lateral condyle fractures/

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The Message : -When in doubt pin -Follow until fully healed Clinically and Radiographically

Stage II Closed Reduction and fixation:

Stage II Closed Reduction and fixation

Stage 3 lateral condyle:

Stage 3 lateral condyle

Perfect Articular and physeal reduction:

Perfect Articular and physeal reduction

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Successful CR in 18 of 24 patients (75%) Results by Hardacre cliteria excellent in 17 (94%) and good in 1

Late Presentation Lateral Condyle Fractures in Children:

Late Presentation Lateral Condyle Fractures in Children Taral Nagda Dr Sushal Shanthakumar Rajeev Nirawane www.ipodindia.org

Child with elbow injury:

Child with elbow injury Day 1 Case courtsey Dr Sandeep Patwardhan Day 7 Day 14

The Natural History:

The Natural History www.ipodindia.org

8 year old child Elbow injury 3 years back:

8 year old child Elbow injury 3 years back Injury Film 3 years after injury www.ipodindia.org

8 year old child Elbow injury 3 years back:

8 year old child Elbow injury 3 years back Injury Film 3 years after injury www.ipodindia.org

40 year old lady Elbow Injury in childhood:

40 year old lady Elbow Injury in childhood www.ipodindia.org

What is the evidence from literature?:

What is the evidence from literature? www.ipodindia.org

Case of 10 year old treated for ORIF lateral condyle fracture:

Case of 10 year old treated for ORIF lateral condyle fracture

What are the results of open reduction and fixation in late presenters:

What are the results of open reduction and fixation in late presenters

What do late presentors present with?:

What do late presentors present with? www.ipodindia.org

Cubitus Valgus:

Cubitus Valgus www.ipodindia.org

Tardy Ulnar Nerve Palsy:

Tardy Ulnar Nerve Palsy www.ipodindia.org

Instability:

Instability www.ipodindia.org

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Group 1 Group 2 www.ipodindia.org

How do we treat the late presenters?:

How do we treat the late presenters? www.ipodindia.org

Problem oriented Solutions:

Problem oriented Solutions If you can not fix the nonunion what do we treat?

ROM Good Deformity Acceptable Instability Absent Palsy Absent :

ROM Good Deformity Acceptable Instability Absent Palsy Absent Situation 1 Observation Solution

ROM Good Deformity Acceptable Instability Absent Palsy Present :

ROM Good Deformity Acceptable Instability Absent Palsy Present Situation 2 Transposition of Ulnar nerve Solution

ROM Good Deformity Unacceptable Instability Absent Palsy Present :

ROM Good Deformity Unacceptable Instability Absent Palsy Present Situation 3 Osteotomy with or without ulnar transposition Solution

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ROM Good Deformity Acceptable Instability Present Palsy Absent Situation 4 Osteosynthesis in situ Solution

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