Elbow Injuries In Children Research Articles

Ultrasound evaluation of elbow fractures in children.

Elbow fractures are a common pathology in any pediatric emergency unit. X-ray of the elbow is the standard diagnostic procedure. Previous studies have shown that fractures can also be visualized by ultrasound (US). The aim of our study was to evaluate the diagnostic accuracy of US in comparison to X-rays in diagnosing pediatric elbow fractures. Sixty-seven patients aged 1-13years with clinically suspected elbow fracture were first examined by US followed by standard two-plane radiographs. US examination was done with a 12-MHz linear probe from seven longitudinal positions across the distal humerus and additionally from longitudinal positions across the radial head and olecranon. The sonographic and radiological findings were compared in a contingency table, and sensitivity, specificity, and positive and negative predictive values of the US diagnostic procedure were calculated. With X-ray, we found 48 patients with an elbow fracture and 19 patients with no fracture. With US, we found 46 patients with an elbow fracture and 21 patients with no fracture. In comparison to X-ray diagnosis, we calculated for US diagnosis a sensitivity of 97.9%, a specificity of 95%, a negative predictive value of 95%, and a positive predictive value of 97.9%. Typical elbow fractures in children could also be visualized by US. A positive fat pad sign, in particular, serves as a strong indicator for elbow joint fractures and can be identified very sensitively by US. We confirm US as a valuable primary screening tool for elbow injuries in children. In the absence of US signs of fracture and in sonographically confirmed non-displaced fractures, standard X-rays are dispensable, thereby minimizing the X-ray burden in children without loss of diagnostic safety.

Deriving the East Riding Elbow Rule (ER2): a maximally sensitive decision tool for elbow injury

ObjectiveTo derive a maximally sensitive decision rule for clinical practice to rule out the need for x-ray examination after elbow injury in adults and children.MethodsEmergency department patients with acute elbow...

Percutaneous K-wire fixation in paediatric Supracondylar fractures of humerus: A retrospective study

Background:Supracondylar fractures are the commonest elbow injury in children. Most displaced Supracondylar fractures are manipulated and held with a medial/lateral entry or two lateral Kirschner wires. It was the purpose of this study to investigate the treatment of this injury in this unique patient population.Materials and Methods:This study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from July 2005 to July 2010. One hundred seventy patients were recruited from Emergency and outpatient department having closed displaced Supracondylar fractures of humerus in children. They were treated either with medial-lateral pin fixation (n = 85) or with 2-lateral pin fixation (n = 85). All patients were operated under general anaesthesia. All patients were followed for 6 months. Results were analysed using Flynn's criteria.Statistical Analysis Used:Chi Square Test. Chi Square calculator was used as a software.Results:All children achieved union in a mean time of 4 weeks (range: 3-6 weeks). Post-operatively, eight patients (4.70%) got ulnar nerve injury and six (3.52%) patients got pin tract infection. Comparison between two groups such as cross K-wire group (85) and lateral K-wire group (n = 85) by using the Chi Square Test showed that in case of 8 weeks with (P-values = 0.89), in 16 weeks (P = 0.91) and 24 weeks (P = 0.85) with respective excellent, good, fair and poor categories were not found statistically significant.Conclusion:The lateral percutaneous pinning technique of displaced Supracondylar fractures of the humerus offers a viable alternative to the crossed pinning group as it offers the same stability without the incipient risk of iatrogenic ulnar nerve injury.

Ultrasound Evaluation of Elbow Injuries in Children

Ultrasound Evaluation of Elbow Injuries in Children

Paediatric elbow injuries. Part 2: Assessment of paediatric elbow X-rays, identification and management of supracondylar fractures

Summary This is the second of a two part series to address simple elbow injuries in children. The first in this series described the assessment of the injured elbow and identification and management of a pulled elbow. The focus of this paper is the differences between children's and adults' bones and the radiographic features that are unique to the paediatric elbow. Using a case study the features of supracondylar fractures and the management of this injury will be described.

Paediatric elbow injuries

Summary This is the first article of a two part series to address simple elbow injuries in children. It will focus on assessment of the injured elbow, addressing techniques to overcome the challenges of examining young children and the features indicative of significant injury in this age group. A case study will be used to illustrate the most common features of a pulled elbow and how this injury is managed. The second article in the series will concentrate on the differences between children's and adults' bones, the radiographic features that are unique to the paediatric elbow and supracondylar fractures.

Range of elbow movement as a predictor of bony injury in children

BackgroundThe aim of this study was to determine whether a normal range of elbow movement can be used as a rule out tool for significant injury after blunt trauma in...

“No bony injury seen”: radial head dislocation

Isolated radial head dislocation is a relatively uncommon elbow injury in children but is also easily overlooked. A 9-year-old boy who fell off his bike presented with a stiff, painful...

Mechanical Distraction for the Treatment of Posttraumatic Stiffness of the Elbow in Children and Adolescents

Elbow contracture is a recognized sequela of elbow injuries in children and adolescents, but previous studies of operative treatment with formal capsular release have demonstrated unpredictable outcomes and unfavorable results. Over a period of five years, fourteen children and adolescents with a mean age of fourteen years who had posttraumatic stiffness of the elbow were managed according to a prospective protocol. Eleven patients had undergone a mean of three previous operative procedures before the index operation. After intraoperative distraction with an external fixator, there was a relaxation phase for six days followed by mobilization of the elbow joint under distraction in the fixator for a mean of seven weeks. Intraoperative range of motion under distraction reached a mean of 100 degrees . Open arthrolysis was not performed, but in four children impinging heterotopic bone was removed through a limited approach. Decompression of the ulnar nerve was performed in seven patients. The mean preoperative arc of total elbow motion was 37 degrees . The mean pronation was 46 degrees , and the mean supination was 56 degrees . After a mean duration of follow-up of thirty-four months, all patients but two had achieved an arc of motion of 100 degrees . The mean arc of flexion-extension was 108 degrees (range, 75 degrees to 130 degrees ). The mean range of pronation was 73 degrees (range, 20 degrees to 90 degrees ), and the mean range of supination was 75 degrees (range, 10 degrees to 90 degrees ). There were no pin-track infections or deep infections, and all elbows were stable. At the time of follow-up, three patients had radiographic evidence of humeroulnar degeneration. Closed distraction of the elbow joint with use of a monolateral external fixation frame with motion capacity yields more favorable results than other previously reported options for the treatment of posttraumatic elbow contractures in children and adolescents.

Les fractures de l'épicondyle médial chez l'enfant

Medial epicondylar fractures account for 11% of elbow injuries in children. It represents a Salter-Harris type I lesion. Diagnosis is difficult but on the whole, results are satisfactory. The treatment of this fracture is controversial. Our study looked at fifty-nine patients between 7 and 14 years old. The main mechanism of injury in our study was a fall (98%). The significance of the fracture displacement was judged according to the classification of Marion and Faysse. We noted 10 cases of stage II, 14 cases of stage III and 35 cases of stage IV according to their classification. Forty-one patients were treated by surgical fixation. Fifty patients were reviewed at an average of six years follow up and the results evaluated according to the criteria of Hardacre. The result was good in 95% of those cases with conservative treatment and in 80% of those cases with operative treatment. Prominence of the medial epicondyle and limitation of elbow motion were the main complications. According the literature, a sports accident is the most frequent cause of the injury. The results are better with conservative treatment because there is no relation between fracture displacement and final results. The excellent results of conservative treatment permit us to recommend this method except in those cases with a persistent intra-articular fragment or neurovascular complication.

MECHANICAL DISTRACTION FOR THE TREATMENT OF POSTTRAUMATIC STIFFNESS OF THE ELBOW IN CHILDREN AND ADOLESCENTS

Background: Elbow contracture is a recognized sequela of elbow injuries in children and adolescents, but previous studies of operative treatment with formal capsular release have demonstrated unpredictable outcomes and unfavorable results. Methods: Over a period of five years, fourteen children and adolescents with a mean age of fourteen years who had posttraumatic stiffness of the elbow were managed according to a prospective protocol. Eleven patients had undergone a mean of three previous operative procedures before the index operation. After intraoperative distraction with an external fixator, there was a relaxation phase for six days followed by mobilization of the elbow joint under distraction in the fixator for a mean of seven weeks. Intraoperative range of motion under distraction reached a mean of 100°. Open arthrolysis was not performed, but in four children impinging heterotopic bone was removed through a limited approach. Decompression of the ulnar nerve was performed in seven patients. Results: The mean preoperative arc of total elbow motion was 37°. The mean pronation was 46°, and the mean supination was 56°. After a mean duration of follow-up of thirty-four months, all patients but two had achieved a functional arc of motion of 100°. The mean arc of flexion-extension was 108° (range, 75° to 130°). The mean range of pronation was 73° (range, 20° to 90°), and the mean range of supination was 75° (range, 10° to 90°). There were no pin-track infections or deep infections, and all elbows were stable. At the time of follow-up, three patients had radiographic evidence of humeroulnar degeneration. Conclusions: Closed distraction of the elbow joint with use of a monolateral external fixation frame with motion capacity yields more favorable results than other previously reported options for the treatment of posttraumatic elbow contractures in children and adolescents. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Mechanical Distraction for the Treatment of Posttraumatic Stiffness of the Elbow in Children and Adolescents

Elbow contracture is a recognized sequela of elbow injuries in children and adolescents, but previous studies of operative treatment with formal capsular release have demonstrated unpredictable outcomes and unfavorable results. Over a period of five years, fourteen children and adolescents with a mean age of fourteen years who had posttraumatic stiffness of the elbow were managed according to a prospective protocol. Eleven patients had undergone a mean of three previous operative procedures before the index operation. After intraoperative distraction with an external fixator, there was a relaxation phase for six days followed by mobilization of the elbow joint under distraction in the fixator for a mean of seven weeks. Intraoperative range of motion under distraction reached a mean of 100 degrees. Open arthrolysis was not performed, but in four children impinging heterotopic bone was removed through a limited approach. Decompression of the ulnar nerve was performed in seven patients. The mean preoperative arc of total elbow motion was 37 degrees. The mean pronation was 46 degrees, and the mean supination was 56 degrees. After a mean duration of follow-up of thirty-four months, all patients but two had achieved a functional arc of motion of 100 degrees. The mean arc of flexion-extension was 108 degrees (range, 75 degrees to 130 degrees). The mean range of pronation was 73 degrees (range, 20 degrees to 90 degrees), and the mean range of supination was 75 degrees (range, 10 degrees to 90 degrees). There were no pin-track infections or deep infections, and all elbows were stable. At the time of follow-up, three patients had radiographic evidence of humeroulnar degeneration. Closed distraction of the elbow joint with use of a monolateral external fixation frame with motion capacity yields more favorable results than other previously reported options for the treatment of posttraumatic elbow contractures in children and adolescents.

Comparison views to diagnose elbow injuries in children: a survey of Canadian non-pediatric emergency physicians

Elbow injuries in children are a common presenting complaint to the emergency department. Although radiography is a valuable tool in the diagnosis of this injury, x-rays of the injured elbow are inherently difficult to interpret. As a result, comparison views of the uninjured arm have traditionally been recommended to provide an anatomically "normal" radiograph. Recent studies have questioned the use of comparison views in the pediatric emergency department. The primary objective of this study was to determine current practices of non-pediatric emergency physicians in the use of comparison views for the diagnosis of elbow injuries in children. A self-administered mail survey was sent to 300 randomly selected emergency physicians, using the Canadian Association of Emergency Physicians database. Two hundred and forty-two (81%) responses were received; 26 were excluded based on pre-determined criteria. Of eligible respondents, 95% ordered comparison views selectively and 64% of these physicians ordered comparison views infrequently. Eighty-eight percent found the comparison views to be "rarely" to "sometimes" useful. Forty-seven percent of respondents stated that they were only "somewhat" confident when interpreting x-rays of a child's elbow. This survey demonstrates that non-pediatric emergency physicians are using comparison views selectively for elbow injuries in children, despite being only "somewhat" confident in interpreting the x-rays.

Common elbow injuries in children: evaluation, treatment, and clinical outcomes

Summary The information in this review may help orthopedic surgeonswho encounter these injuries to further improve their treatmentmethods. Further research is needed to continue to refinethese methods and reduce the incidence of adverse sequelae. Keywords pediatric, elbow, trauma Curr Opin Orthop 15:286–294. © 2004 Lippincott Williams & Wilkins. Introduction Acutetraumatothepediatricelbowcreatesinjuriesthatareamongthemostconcerningfororthopedicsurgeonstoencounter.Theuniqueanatomyandtheintimatelo-cationofneurovascularstructuresoftenresultinaspec-trumofinjurywithassociatedcomplicationsandpoten-tiallong-termdisability.Mostelbowinjuriesinchildrenareobviousintheirpre-sentation.Swelling,tenderness,limitedrangeofmotion,orgrossdeformityafteratraumaticeventwilloftenleadthefamilytoseekmedicalattention.High-qualityradio-graphsarediagnosticinmostcases.Yetthepresentationofnondisplaced,oroccult,elbowfracturescanbesubtle.Theposteriorfatpadsignonaradiographhasrecentlybeenshowntobe76%effectiveinpickingupanoccultfractureabouttheelbow[1].Thisfindingshouldthere-forepromptthetreatingphysiciantoimmobilizetheel-bowasifafracturewerepresent.Inthepresenceofaclearlyidentifiedfracture,itisim-perativetoperformacompleteneurologicandvascularexaminationatthetimeofinitialpresentationtodocu-menttheleveloffunctionbeforetreatment.Thisisbe-causeofthemoderaterateofneurovascularcomplica-tionsinchildrenwithelbowinjuriesrelatedtotheinjuryitself,thetreatmentprovided,orboth.Mostchildrenwhohavesustainedelbowtraumacanbeexpectedtohaveafullfunctionalrecoveryiftheyaretreatedpromptlywithappropriateinterventionandcur-rentlyacceptedtechniques.Thisarticlereviewstheclas-sification,treatment,outcomes,andcomplicationsofthemostcommonpediatricelbowinjurieswithattentiontorecentcontributionsintheliterature.

Elbow injuries in children.

Elbow injuries in children.

A Technique to Determine Proper Pin Placement of Crossed Pins in Supracondylar Fractures of the Elbow

Supracondylar humerus fractures are the most common elbow injury in children. Stable fractures can be closed, reduced, and casted, whereas unstable fractures require percutaneous pinning. Studies have shown that there is a biomechanical advantage of crossed pin fixation as opposed to two lateral pin fixation. However, medial pin placement has the risk of injuring the ulnar nerve. This modification of technique was used on 46 patients, aged 12 months to 14 years (median age, 3.6 years). Two patients had an ulnar sensory and motor neurapraxia, and two patients had cubitus varus deformities postoperatively. Thus, a safe, easy, and reproducible technique of crossed pin fixation is described here.

Fractures of the radial head and associated elbow injuries in children.

Fractures of the radial head are frequently associated with elbow injuries in children. Thirty-seven patients with this association treated at the Nancy Children's Hospital were analyzed to ascertain the mechanism and the unfavorable factors of prognosis. The mechanism responsible was a valgus strain on the elbow at the moment of impact, associated with forces of compression and distraction. At an average follow-up of 2 years, 76% excellent and good results were obtained. Conservative treatment was always effective in minimally displaced fractures. With surgical reduction by closed intramedullary pinning (CIMP), there were only three failures in severely displaced fractures. With open reduction, results were always poor; 88% patients with fair and poor results had an associated fracture of the olecranon. The unfavorable prognostic factors were the severity of the initial tilting and displacement, the presence of associated elbow injuries, the inadequacy of reduction, and the open reduction procedure.

Pediatric elbow fractures: MRI evaluation.

Magnetic resonance imaging (MRI) was performed in eight patients under the age of 8 years who suffered elbow fractures, to assess possible fracture extension into the distal nonossified epiphysis of the humerus in seven cases and to determine the displacement and location of the radial head in one case. MRI allowed accurate depiction of the fracture line when it extended into the cartilaginous epiphysis. In four cases, MRI findings were confirmed at surgery. In five cases, surgery was obviated because no articular extension of the fracture was seen on MRI (4 cases) or because no displacement was noted (1 case). In one patient, the plain film diagnosis of a Salter type II fracture was changed to Salter type IV on the basis of the MRI findings. It is concluded that MRI might play a role in the preoperative evaluation of pediatric patients presenting with elbow trauma when extension of the fracture cannot be determined with routine radiographic studies. Elbow injuries in children may be difficult to diagnose by routine clinical and radiographic techniques [1, 4, 12, 14]. Diagnostic difficulty is due to the presence of multiple ossification centers of the distal humeral epiphysis and proximal radius and ulna; these are mostly cartilaginous until the age of 11-12 years and therefore invisible on radiographs. Following distal radial and distal tibial physeal fractures, epiphyseal elbow injuries are the most frequent epiphyseal injuries [8, 16]. These fractures tend to be unstable and often require surgical intervention. In addition, lasting sequelae such as cubitus valgus and delayed ulnar nerve palsy can occur if these fractures are not treated properly [8].(ABSTRACT TRUNCATED AT 250 WORDS)

Ulna Neuropathy After Elbow Injury in Children

Summary: Six children developed seven cases of ulna neuropathy between 7 days and 6 years after significant elbow injury. None had evidence of acute nerve damage at the time of initial trauma. This complication, which develops soon after injury, has not been well documented. For this reason, the mode of presentation, treatment options, and review of the literature is presented.

Ulna Neuropathy After Elbow Injury in Children

Six children developed seven cases of ulna neuropathy between 7 days and 6 years after significant elbow injury. None had evidence of acute nerve damage at the time of initial trauma. This complication, which develops soon after injury, has not been well documented. For this reason, the mode of presentation, treatment options, and review of the literature is presented.