Pediatrics Case #11

History and Physical11 YOM presents with

right elbow pain. Pt was playing on the trampoline with friends. He reports that while his right arm was planted someone fell onto the outer portion of his right elbow. He experienced immediate pain to the inner elbow.

T 98.7 P 102 BP 126/84 O2 99%

Gen: WDWN, obvious pain

CV: Tachycardic, RR, no m/r/g

Pulm: Lungs CTA bilatMusc: medial R elbow

tenderness and swelling; lateral elbow in nontender; decreased ROM 2/2 pain

X-ray

Diagnosis: Medial Epicondyle Fx of the Humerus

Pain ControlReduction/Stabilization

Immobilize the elbow with the forearm in flexion and pronation of the wrist

ED orthopedic consultation for fragment entrapment within the joint or ulnar neuropathy

Orthopedic surgery follow up for re-evaluation and possible ORIF if displaced >5mm

ED Management

Tends to occur in older children (10-14yo)Not a true Salter Harris injury (involves the

apophysis rather than the physis)Third most common elbow fx (5-10%, behind

supracondylar and lateral epicondyle)About half of medial epicondyle fractures are

associated with elbow dislocation or subluxationCan occur from FOOSH or valgus stressAssess for ulnar neuropathy as ulnar nerve runs

posterior to the condyleMajor complication is entrapment of the fracture

fragment within the elbow joint

Pearls

Additional Image

http://www.hss.edu/conditions_elbow-fractures-children-overview.asp

http://reference.medscape.com/features/slideshow/pediatric-fractures

http://pediatricsportsmed.blogspot.com/2010/09/ucl-tear.html

Tintinalli's Emergency Medicine: A Comprehensive Study Guide. Chapter 133 Musculoskeletal Disorders in Children.

http://www.wheelessonline.com/ortho/medial_epicondyle_frx_of_the_humerus

References