Traumatic Elbow Swelling

aka Bone and Joint Bamboozler 007 This 5 year old presented to ED with elbow pain and swelling after falling onto his left outstretched arm. The XR is shown. Questions What is the abnormality? Answer expand(document.getElementById('ddet1224948095'));expand(document.getElementById('ddetlink1224948095')) Supracondylar fracture There is a posterior fat pad. Anterior fat pads are normal, although a large anterior fat pad (based on subjective judgement) can be abnormal (sail sign). The mantra goes that posterior fat pads are always abnormal – 75% of them have fractures. Fat pads generally demonstrate intra-articular disruption. How do you grade this injury? Answer expand(document.getElementById('ddet1045550980'));expand(document.getElementById('ddetlink1045550980')) Gartland I supracondylar fracture. The posterior fat pad and the history indicate a likely supracondylar fracture. These are the most common elbow injuries in kids between 5 and 8 years. Some can have anterior displacement of the distal humerus (flexion-type) but most are extension-type injuries. The anterior humeral line should go through the middle third of the capitellum. If it doesn’t then this indicates displacement. AP views are also helpful but in a Gartland I often there will be no fracture visible on AP. Gartland Classification Gartland I – no displacement Gartland II – posterior displacement of the distal end of the humerus but with intact cortex (image 3) Gartland III – complete displ...
Source: Life in the Fast Lane - Category: Emergency Medicine Doctors Authors: Tags: Emergency Medicine Featured Orthopedics Pediatrics Bone and Joint Bamboozler Elbow fracture paediatrics supracondylar fracture Trauma X-Ray Source Type: blogs