Fx de condilo lateral

En trauma de codo representan el 15% de lesiones en ninos. Caida en hiperextensin de brazo.

Clasificacin de Jakob
Tipo 1: No desplazadas, trazo de fractura no cruza superficie articular. Tipo 2: Minimo desplazamiento. Trazo se extiende por superficie articular, con capitelo no rotado o desplazamiento signifitcativo. Tipo 3: Desplazamiento completo. Compromiso articular. Capitelo rotado, desplazado.

Fx condilo lateral

Manejo Tipo 1
Inmovilizacin en yeso cerrado.

Manejo Tipo 2
Con desplazamiento >2mm en Rx RC + FP Debe asegurarse reduccin anatmica de la articulacin. Reduccin abierta de ser necesario

Manejo Tipo 3
RAFI Acceso lateral para preservar tejidos blandos e irrifgacin vascular (Kocher).

Manejo Tipo 3

Complicaciones
No-union: Sucede en casos no tratados (desp >2mm) o desplazamiento bajo yeso. Cubito varus Neuropatia N. Cubital

Fx Epicondilo Medial
5 a 10% de fracturas de codo en ninos Traume en valgo con avulsion del epicondilo medial. Asociado con luxacion de codo

Medial Epicondyle Fracture

~12% of paeds elbow fractures Common between 10-14 years, majority male Associated with dislocations ~50% Mechanism
Avulsion of epicondyle by forearm flexors with valgus stress

Medial Epicondyle Fracture

Classification
Degree of displacement (< or > 5 mm) +/- trapped fragment +/- dislocation of elbow

Medial Epicondyle Fracture

Management
Minimally displaced
Long arm splint 1-2 weeks with early ROM

Displaced >5mm
Conservative or operative

Intra-articular fragment
Surgical removal of fragment

Medial Epicondyle Fracture

Complications
Ulnar nerve injury 10-16%
More common if intraarticular fragment

Manejo
No desplazadas o desplazamiento <5mm Inmovilizacion y posterior movilizacion temprana para evitar rigidez. Desplazamiento >5mm
Manejo Qx
Atletas Fragmento atrapado con incongruencia articular posterior a luxacion.

Estudios a largo plazo favorecen manejo ortopedico.

Manejo

Avulsion + Luxacion

Posterior a reduccion, desplazamiento de epicondilo es >5mm

Manejo

Fx Olecranon
Asociada a luxacion de codo o fractura de cabeza radial. Olecranon oscifica hacia los 8-9 anos. En ninos mayores ocurre a traves de su fisis Reduccion anatomica es necesaria par a preservar flexoextension.

Fx Olecranon
Mecanismo
Golpe directo Hiperextension

Manejo
Extra-articular
Desplazamiento <3 mm
Inmovilizacion

Desplzamiento >3 mm
Reduccion cerrada Inmovilizar segun mecanismo Hyperextension/Shear - cast in flexion Hyperflexion - cast in extension

Intra-articular
ORIF

Fx Olecranon
Complicaciones
Lesion N.Cubital No-union Arthritis Pobre fuerza extensora

Fx Olecranon

Rare Distal Humeral Fractures

Lateral Epicondyle: rare, usually represent a small avulsion fracture. Treated with early mobilization. T-Condylar fractures: occur in patients that are almost skeletally mature. Treatment similar to adult intra-articular elbow fractures. Medial Condyle: rare, treated with ORIF if displaced.

Radial Head and Neck Fractures

Radial neck > head fractures Often minimal physical findings Mechanism
FOOSH Elbow extended and in valgus

Associated with other injuries in ~ 50% of cases

Radial Head and Neck Fractures

Classification
By degree of angulation

Type I
< 30 angulation

Type II
30 -60 angulation

Type III
> 60 angulation

Radial Head and Neck Fractures

Management Angulation>15 - closed reduction Type I
Sling/posterior splint X 1-2 weeks

Type II and III

Percutaneous pining if closed reduction not adequate (<30)

Radial Head and Neck Fractures

Complications
AVN of radial head ~ 10 -20% Loss of ROM
rotation

Proximal Radial Fractures

1% of children s fractures 90% involve physis or neck Normally some angulation of head to radial shaft (0-15 degrees) No ligaments attach to head or neck Much of radial neck extraarticular (no effusion with fracture)

Proximal Radial Fractures - Types

Valgus fractures Salter I or II (intraarticular fractures rare) Metaphyseal fractures Associated with elbow dislocations or proximal ulna fractures Can be completely displaced, rotated

Proximal Radius Fractures- Treatment

Greater than 30 degrees angulation- manipulate Usually can obtain acceptable reduction in fractures with less than 60 degrees initial angulation Traction, varus force in supination & extension, flex and pronate Ace wrap or Esmarch reduction

Proximal Radius Fractures- Treatment

Unable to reduce closed Percutaneous pin reduction Intramedullary pin reduction Open reduction via lateral approach

Completely Displaced, Malrotated Radial Neck Fracture

After closed reduction the articular surface (arrow) is facing distally, 180 degrees malrotated

Proximal Radial Fractures - Complications

Loss of forearm rotation Radial head overgrowth Premature physeal closure valgus Nonunion of radial neck rare AVN Proximal synostosis

100% Displaced, Failed Closed Reduction

Open closed reduction- blunt pin to push radial head back onto neck

Pin Fixation Augmented by LAC for 3 Weeks