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Pediatric Olecranon Fracture
From WikiSM
Other Names
- Elbow Fracture
Background
Epidemiology
- Uncommon fracture pattern in children
- Represent approximately 5% of elbow fractures in children[1]
- Occurs most commonly between ages 5-10[2]
- 65% male
Pathophysiology
- Mechanism typically involves fall on outstreched arm
- Flexed elbow with contracting Triceps Brachii, Brachialis may lead to avulsion fracture (less common in children)
- Extended elbow
- Direct trauma
- Stress fracture can occur from overuse injury and be subacute
- Types
- Short, oblique
- Transverse
Pathoanatomy
- Location
- Metaphyseal (most common)
- Physeal
- Epiphyseal
- Intra-articular
- Extra-articular
Ossification Centers of the Elbow
| Ossification center | Age of Appearance on Xray | Age of fusion |
| Capitellum | 1 | 12 |
| Radial Head | 3 | 15 |
| Medial Epicondyle | 5 | 17 |
| Trochlea | 7 | 12 |
| Olecranon | 9 | 15 |
| Lateral Epicondyle | 11 | 12 |
Associated Injuries
- Up 14 to 77% associated with other injuries[3]
- Radial Head Fracture
- Lateral Condyle Fracture
- Distal Radius Fracture
- Distal Humerus fracture
- Monteggia Fracture
Risk Factors
Differential Diagnosis
- Fractures
- Adult
- Pediatric
- Dislocations & Instability
- Tendinopathies
- Bursopathies
- Ligament Injuries
- Neuropathies
- Arthropathies
- Other
- Pediatric Considerations
- Little League Elbow
- Panners Disease (Avascular Necrosis of the Capitellum)
- Nursemaids Elbow (Radial Head Subluxation)
Clinical Features
- General: Physical Exam Elbow
- History
- Patient will endorse trauma
- Reports pain, swelling, bruising, inability to flex or extend elbow
- Physical
- Inspect for swelling, bruising
- Loss of range of motion
Evaluation
Radiographs
- Standard Radiographs Elbow
- Standard elbow radiographs usually sufficient
- May see lucency usually reaching the trochlear groove articular surface
Classification
- N/A
Management
Nonoperative
- Indications
- Stress fracture or reactions
- Apophysitis
- Minimally displaced fractures, typically <2 mm
- Immobilization in Long Arm Cast for acute injuries
- NSAIDS
- Relative rest
- Avoidance of provocative activities
- Physical Therapy
Operative
- Indications
- Displaced fractures >2 mm
- unstable or comminuted
Return to Play
- Variable
- For overuse injuries, graduated return to play
Complications
- Nonunion
- Delayed Union
- Acute Compartment Syndrome
- Ulnar Nerve Injury
- Loss of Reduction
- Elbow stiffness/ loss of range of motion
See Also
- Internal
- External
- Sports Med Review Elbow Pain: https://www.sportsmedreview.com/by-joint/elbow/
References
- ↑ Landin LA, Danielsson LG. Elbow fractures in children. An epidemiological analysis of 589 cases. Acta Orthop Scand. 1986;57(4):309–12.
- ↑ Erickson M, Frick S. Fractures involving the proximal radius and ulna. In: Rockwood CA, Wilkins KE, King RE, editors. Rockwood and Wilkins fractures in children. 7th ed. Philadelphia: J.B. Lippincott. p. 427–42. Section 2 Ch. 11.
- ↑ Evans MC, Graham KH. Olecranon fractures in children: part 1: a clinical review, part 2: a new classification and management algorithm. J Pediatr Orthop. 1999;19(5):559–69.
Created by:
John Kiel on 18 June 2019 01:16:43
Authors:
Last edited:
13 October 2022 13:26:37
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