Detection and assessment of malrotation is difficult and the fate of post-traumatic humeral torsion deformity is unknown. Distal fragment malrotation may lead to instability, fragment tilt and subsequent CV. An injury to the growth plate between the lateral epicondylar center of ossification and the rest of the humerus does not contribute to bone length growth arrest is therefore not an issue 1.After displaced supracondylar humerus fractures (SCHF) in children, residual deformities are common with cubitus varus (CV) being the clinically most visible. In general, young patients have little subsequent impairment. If the ossification is displaced into the joint then operative intervention is required 2. Even if a pseudoarthrosis occurs (non-union) most patients are asymptomatic if symptoms do occur later, surgical intervention can be carried out 1,2. In significantly displaced fractures, rigid internal fixation allowing early mobilization is an option, although conservative management for these patients also is an option 1,2. Undisplaced or minimally displaced injuries can be treated conservatively 1. The other centers of ossification of the elbow should be reviewed to ensure that they are age-appropriate. Any rotation of the center of ossification should also be commented upon. If satisfied that it is indeed displaced then the degree of displacement should be commented upon, as well as whether or not the ossification center is within the joint. When reporting these injuries, care should be taken to ensure that one is not looking at normal ossification of the lateral epicondyle. Some authors suggest a better detection rate with 20° tilted or internal oblique radiographs 6,9. It should also be noted that in children the ossification center can undergo up to 180° of rotation such that the physeal surface is most superficial 3.Īs the late sequelae, there may be lateral spurring (especially in children) 5. Comparison to the contralateral elbow may be of benefit.Ĭertainly, if the ossification center is displaced such that it lies distal to the growth plate between the metaphysis and center of ossification for the capitellum, then significant displacement is present. When ossification is present then care must be taken in not over-calling separation, on account of the apophysis beginning its ossification laterally, and as such the gap between the ossified component and the rest of the humerus can be considerable 2. ![]() ![]() The key to correctly interpreting pediatric elbow injuries is an understanding of the order and age at which the various secondary centers of ossification become visible (see ossification centers of the elbow).īefore the apophysis begins to ossify (10-11 years of age), soft tissue swelling may be the only finding, and the degree of displacement cannot be evaluated on plain films. Plain films usually suffice in both making the diagnosis and determining treatment. In adults, lateral epicondylar fractures are usually due to a direct blow 2. In children, these injuries are believed to occur due to sudden traction on the common extensor origin by the extensor musculature. Incidence typically peaks in the pediatric age group (6-7 years of age) 7. They are distinct from a lateral condyle fracture which is a very different fracture despite the similar name. ![]() These fractures are avulsion fractions of the ossification center of the lateral condyle, and as such are sometimes referred to as a lateral epicondyle avulsion fracture either term is acceptable.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |