This document discusses fractures around the elbow joint that commonly occur in children, including supracondylar fractures of the humerus, lateral condyle fractures of the humerus, and distal radial fractures. It provides details on the classification, epidemiology, clinical presentation, complications, and treatment options for these pediatric elbow injuries. Common fracture types are described along with approaches to nonoperative and operative management depending on the degree of displacement and integrity of the articular surface. Complications addressed include malunion, growth disturbances, and avascular necrosis.

1. Prepared by:
Dr. Mostafa Azab
Lecturer of Orthopedic Surgery
Cairo University

2. Supracondylar Fracture of the
Humerus
Is a fracture, usually of the
just abovehumerusdistal
the
, although it mayepicondyles
occur elsewhere. While
relatively rare in adults it is
one of the most common
fractures to occur in
children and is often
associated with the
development of serious
complications.

3. Classification:
Flexion Type:20%Extension Type:80%

4. TYPES:
There are three types based on the degree of
separationof the fractured fragments:
1-Type I: undisplaced or minimally displaced fractures.
2-Type II: partially displaced.
3-Type III: fully displaced.

5. Epidemiology
1-This is the most common elbow fracture in children.
2-About 60% of fractures in children.
3-It is most common in children <10.
4- Peak incidence is between the ages of 5-8 years of age.
5-Primarily in children who are around age 7 years.

6. Presentation:
The child presents with history of a falling on an
outstretched hand .
Followed by pain, swelling and inability to move the
affected elbow.
On examination: Unusual prominence of olecranon
process but because it is a supracondylar fracture, the
three bony point relationship is maintained, as in a
normal elbow.

7. Complications:
1- Brachial Artery Injury
2- Nerve Injuries
3-Volkmann’s Ischaemic
contracture
4-Myositis ossificans
5-Mal-union(Cubitus
Varus)

8. Cubitus Varus

9. Treatment

10. Treatment:
Closed Reduction& percutaneus
Fixation

11. Lateral Humeral Condyle Fractures
Lateral condyle fractures
are common and their
outcomes have historically
been worse than
supracondylar fractures
articular nature, and
often,
missed diagnosis lead to
an unacceptably high
incidence of malunion
and nonunion.

12. Epidemiology & Types:
6 Years old is the
commonest age

13. Classification:
Type I: SH Type IV
TypeII: SH TypeII

14. According to Displacement:
Classification based on
fracture displacement:
Type 1:
displacement
<2mm, indicating intact
cartilaginous hinge
Type 2:
displacement 2-
4mm, displaced joint
surface
Type 3:
displacement >4mm, joint
displaced and rotated

15. Diagnosis:
Physical exam:
Exam may lack the obvious deformity often seen with
supracondylar fractures.
Swelling and tenderness are usually limited to the lateral side.
Imaging:
Radiographs:
If the lateral condyle and capitellum have not ossified then
radiographic findings can be subtle.
Contra-lateral radiographs are very important.
MRI and arthrograms can be helpful as well
best judge if intra-articular incongruity.

16. X-Rays

17. Treatment
Nonoperative
long arm casting:
Indications :
Only indicated if < 2 mm of displacement, which indicates the cartilaginous hinge is most likely
intact.
Technique
follow patient very closely (every 4-5 days)
Operative
CRPP:
Indications:
closed reduction achieves adequate reduction with no evidence of intra-articular incongruity
Technique.
Divergent pin configuration most stable
open reduction and percutaneous pinning
Indications:
if > 2mm of displacement
any joint incongruity
Technique:
Kocher lateral approach used
avoid dissection of posterior aspect of lateral condyle (source of vascularization)
intraoperative arthrograms are valuable to delineate the fracture and ensure anatomic reduction

18. Complications
1-Lateral overgrowth bump
2-AVN
posterior dissection can result in lateral condyle
osteonecrosis
3-Nonunion/malunion :
caused from delay in diagnosis and improper treatment
may result in cubitus valgus and tardy ulnar nerve palsy

19. Cubitus Valgus

20. Pulled Elbow(Nursemaid’s Elbow)
 Age: 1 to 4 yrs
 Elbow is pronated and
flexed
 Painful movements

21. Reduction

22. OTHER INJURIES
FREQUENCYINJURYELBOWPEDIATRIC
REQUIRES ORPEAK AGE% ELBOW
INJURIES
FRACTURE TYPE
Majority741%SUPRACONDYLA
R FRACTURE
Rare328%RADIAL HEAD
Majority611%LATERAL
CONDYLE
Minority118%MEDIAL
EPICONDYLE
Minority105%RADIAL HEAD
AND NECK #
Rare135%ELBOW
DISLOCATION
Rare101%MEDIAL
CONDYLE #

23. Distal Radial Injuries
In Adults
In Children

24. Salter Harris Classification
I – S = Slip (separated or
straight across). Fracture of
the cartilage of the physis
(growth plate)
II – A = Above. The fracture lies
above the physis, or Away
from the joint.
III – L = Lower. The fracture is
below the physis in the
epiphysis.
IV – T = Through. The fracture
is through the
metaphysis, physis, and
epiphysis.
V – R = Rammed (crushed).
The physis has been crushed.

25. X-Rays

26. Complications:
Growth Arrest &
Deformity(Madlung Def.)

27. Principles of Treatment
Anatomical Reduction
Fixation by non-threaded wires
Early mobilization

28. Anatomical Features

29. Colle’s Fracture
Extra-articular fracture of
the cancellous bone of
the distal end of the
Radius
Displacement:
1-Shortening
2-Radial Deviation
3- Dorsal Angulation

30. Displacement

31. Mechanism of Injury
Fall on the outstretched
hand

32. Classification
Type I: extra articular, undisplaced
Type II: extra articular, displaced
Type III intra articular, undisplaced
Type IV: intra articular, displaced

33. Diagnosis
-History
-Pain
-Swelling
-Deformity
-Loss of function
-Neuro-vascular

34. Treatment
Closed Reduction and
casting

35. Treatment
Closed Reduction and
percutaneus pinning

36. Treatment
External Fixation

37. Treatment
Open Reduction &
Internal Fixation

38. THANK U

39. Epiphyseal Injuries

49. THANK UU