2018 May/Jun;38(5):e262-e266. Burr, Rebecca G. MD; Burnham, Robert R. Jr MD; Fishman, Felicity G. MD, Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL. Pathy R, Dodwell ER. Zhou H, Zhang G, Li M, Qu X, Cao Y, Liu X, Zhang Y. J Orthop Surg Res. The incidence of phalangeal fractures is the highest in children aged 10 to 14 years, wh Pediatric Phalanx Fractures 2007 Jan. 89(1):58-63. 2. For reprint requests, or additional information and guidance on the techniques described in the article, please contact Rebecca G. Burr, MD, at [emailprotected] or by mail at Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center Maywood, IL 60153. The .gov means its official. Kuoppala E, Parviainen R, Pokka T, Sirvi M, Serlo W, Sinikumpu JJ. Complications of lateral condyle fracture. The presence of a metaphyseal flake fracture is not specific because some medial epicondyle avulsions extend into the metaphysis as a Salter-Harris type II fracture. The lateral epicondyle usually fuses to the distal humeral epiphysis (lateral condyle) before fusing to the metaphysis. Salter-Harris type IV injuries will often follow typical location patterns and most commonly involve the distal radius, phalanges and distal tibia. [38, 1, 39]. Monteggia variant. J Pediatr Orthop. While transphyseal distal humerus fractures are rare, the true incidence may be Skaggs DL, Flynn JM. This view also demonstrates the normal angulation between the radial neck and shaft. When associated with a crush injury, open fracture is more likely. You will likely wear a cast or splint for 2 to 6 weeks after surgery. The patient saves significant time by undergoing the procedure in the ER as well by avoiding the additional time to be indicated for the procedure, whether urgent or as an outpatient. Fat pad signs indicate an elbow joint effusion. With such bending, the joint capsule applies a tension force to the anterior cortex of the distal humerus, accounting for the frequent anterior position of the lucent fracture line. A fracture of the thumb can be held in proper alignment using external fixation. For these fractures, the lateral crista of the trochlea is intact, maintaining stability of the elbow joint. In 94% of supracondylar fractures, an abnormally posterior position of the capitellum is demonstrated by passage of the anterior humeral line anterior to the middle third of the capitellum. Displaced lateral condyle fracture. Bone fixation techniques include devices that hold the bone fragments in place either inside the body (internal fixation) or outside the body (external fixation). A distal phalanx is one of the tubular long bones found in each of the fingers [1, 2]. [35], The rate of flexion-type fractures has been estimated to be 1.2%. Distal phalanges are the most exposed phalanges and are, therefore, fractured more often than other hand fractures. Fracture is obvious on both the anteroposterior (A) and lateral (B) views. Supracondylar fracture. J Child Orthop. The technique is cost and time effective when treating patients with this type of injury. modify the keyword list to augment your search. Unfortunately, access to procedure rooms and appropriate surgical instrumentation may not be possible at all health care facilities. Beaty JH, Kasser JR. The most common direction of displacement is posterior or posterolateral (see the images below), although lateral and anterior dislocations also occur. Anteroposterior view shows disruption of the medial cortex. Medial epicondyle fracture with distal displacement of a fracture fragment. Like the other long bones in the hands, each distal phalanx is separated into a head, body or shaft, and a base [3]. In addition to the elbow dislocation, avulsion of the medial epicondyle is noted projecting posterior to the capitellum. Rogers LF, Malave S Jr, White H, Tachdjian MO. The bones. Radiography and referral are recommended for reduction requiring anesthesia and for open reductions.7 Following a simple MCP reduction, radiography is needed to assess congruity of the joint. An avulsion fracture (Figure 5) typically results from forced hyperextension of a flexed DIP joint. 65:371-8. Anteroposterior (A) and lateral (B) views of the injured right elbow compared with anteroposterior (C) and lateral (D) views of the uninjured left elbow. WebDisplaced phalangeal neck fractures may be missed because the fracture may be confused with a distal physis, a minor avulsion fracture, or even a nondisplaced fracture if adequate lateral and oblique films are not obtained. (A) Anteroposterior view shows vertically oriented fracture separating the medial and lateral condyles. encoded search term (Imaging in Pediatric Elbow Trauma) and Imaging in Pediatric Elbow Trauma. Metacarpal fractures are seen more often in adults, whereas phalangeal fractures are more common in children [ 2 ]. Plastic bowing, torus and greenstick supracondylar fractures of the humerus: radiographic clues to obscure fractures of the elbow in children. JAMES R. BORCHERS, MD, MPH, AND THOMAS M. BEST, MD, PhD. (A) On the anteroposterior view, the fracture is seen as a longitudinal lucent line through the medial aspect of the proximal ulna. Treatment of mallet fracture using a percutaneous fixation technique with an 18-gauge needle. Appointments 216.444.2606 Appointments & Locations Milch H. Fractures and fracture dislocations of humeral condyles. Subsequent views (C and D) show lateral and posterior displacement of a distal fragment. Please enable it to take advantage of the complete set of features! [QxMD MEDLINE Link]. This finding must be distinguished from the normal angulation that is usually present at the junction of the radial neck and shaft. In particular, if undergoing an outpatient procedure rather than ER procedure, the patient may need to take additional time off for a preoperative clinic visit and for the surgery. Displaced proximal radial fracture. At the time the article was last revised Mostafa El-Feky had Passage of the anterior humeral line either anterior to the capitellum or through the anterior third of the capitellum demonstrates that the capitellum is positioned too far posteriorly; this finding indicates a distal humeral fracture. Disclaimer. All fingernail beds should point toward the thenar eminence. Baumann angle. Decompress associated subungual hematoma with 18-gauge needle placed through the nail. According to the authors, referral to a nerve specialist following supracondylar fractures is recommended in cases of complete nerve palsy, a positive Tinel sign, or neuropathic pain or vascular compromise. Once the fracture has healed, it is very important to follow all therapy instructions to improve motion in the thumb. Copyright 1995-2021 by the American Academy of Orthopaedic Surgeons. (B) Subsequent radiograph shows abnormality of the medial condyle and varus deformity from a growth plate injury. WebFractures of the distal phalanx are typically treated nonoperatively. Salter-Harris type IV fractures are relatively uncommon injuries that occur in children. Clinical features that suggest a medial condyle fracture include instability and a limitation of elbow motion. See permissionsforcopyrightquestions and/or permission requests. These fractures are caused by an axial load to the tip of an extended finger, leading to forced flexion at the DIP joint.11 A mallet fracture includes a bone fragment attached to the terminal extensor mechanism (Figure 4).