Case report n°2

Medical Staff A&E 14/10/09FVHospital

Dr. David Tran

Case report

Young girl 2 years ½

Coming to A&E because she fell

down to the ground on her right

elbow this morning

Clinic exam: right elbow swelling,

tender to touch

Xray of the right elbow

Details of the right elbow Xray

Management

The orthopedist come to examine the girl: no evident fracture on Xray.

An arm splint is put Prescription of Ibrafen & Efferalgan Advise to consult the orthopedist a

few days later “if not better” An appointment with the orthopedist

is given 5 days later

Follow up… The child didn’t come to the orthopedist

consultation (mistake of communication?) She didn’t sent her daughter to A&E a few

days later because the girl didn’t complain… But 3 weeks later, the girl still refuse to

move her elbow normally > the mother send her daughter to A&E in a Vietnamese hospital

Xray of the right elbow 3 weeks after the trauma

Xray comparison

J 0 J 21

Xray comparison

J 0 J 21

Epicondyle fracture in children

10% of elbow fracture

in child

Frequency 6 to 8 years

Mechanism:

1. Compression/extension

2. Compression/flextion

3. Traction/extension

Classification

Classification de Lagrange et Rigault

-grade I: non déplacé (<2 mm), persistance d'une charnière cartilagineuse ? stabilité ?

-grade II: déplacé (>2 mm), déplacement latéral du fragment condylien

-grade III: déplacement majeur, translation et rotation du fragment condylien

Treatment of epicondyl fracture in children

Stade 1: BABP

(plaster) & orthopedic

consultation 7 days

after (ultrasound)

Stade 2 & 3: surgical

with lateral way pin

http://www.saintluc.be/professionnels/services/orthopedie/traumatologie-pediatrique/pages/0.html

Conclusion

Be care full of Xray in children & infants

(lot of traps…)

Do not hesitate to review the patient

J5/J8

Comparative Xray, Ultrasound or CT

scanner can help us in difficult diagnosis

Basic rule in children’s elbow Xray

Radius axe

Condyle nucleus

Radius axe

Condyle nucleus