Clinical Case Database / Category: Case Based Discussion
Common paediatric orthopaedic conditions
Publication details
A M Wood, MRC S Ed, DJ Bell
Foundation Years Journal, volume 2, issue 9, p.383 (123Doc Education, London, November 2008)
Abstract
An 8-year-old boy presents with a painful right elbow following a fall from a swing onto an outstretched hand. The child is not known to be on the child protection register and is otherwise fit and well. On examination there is extensive swelling around the elbow. The child is reluctant to let you examine the elbow due to the pain, yet the radial and ulnar arteries are found to be present but weak, with a increased capillary refill time of 4 seconds. The child is neurologically intact distal to the injury. A lateral X-ray of the right elbow shows a “fat pad sign†on the lateral view and a visible fracture in the distal humerus with a distal fragment partially tilted and displaced posteriorly. It is not possible to get an anteroposterior (AP) view due to pain. In children under 10 years old, fractures of the elbow are the fourth most common fractures, and the second most common long bone fractures, second only to fractures of the distal radius and ulnar in their incidence. The majority of these injuries are supracondylar fractures, with a peak incidence in children 6–8 years old. The most common cause of injury is for the child to fall onto an outstretched hand and the elbow to be forced into either a valgus or varus direction.
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Authors
A M Wood, MRC S Ed (Corresponding author)
ST3 Trauma and Orthopaedics
Royal Infirmary of Edinburgh
Scotland
sandy@jobscore.co.uk
DJ Bell (Corresponding author)
4th Year Medical Student
University of Leeds
david.bell@ucl.ac.uk
References
1. Solomon L, Warwick D, Nayagam S. Apleys’s System of Orthopaedics and Fractures, 8th edn, 2008. Hodder Arnold.
2. Charnley J. The Closed Treatment of Common Fractures, Golden Jubilee edn, 1999. Cambridge University Press.
3. Miller M. Review of Orthopaedics, 4th edn, 2004. Saunders.
4. Hoppenfield S, DeBoer P. Surgical Exposures in Orthopaedics, 3rd edn, 2003. Lippincott Williams and Wilkins.
5. Banasqkiewicz P. Postgraduate Orthopaedics, 2008. Cambridge University Press.
6. Kling TF, Bright RW, Hensinger RN. Distal Tibial Physeal Fractures in Children that may require open reduction. The Journal of Bone and Joint Surgery, 1984, 66(5):647–657.
7. Im GI, Tae SK. Distal Metaphyseal fractures of tibia: a prospective randomised trial of closed reduction and intramedullary nail versus open reduction and percutaneous screw fixation. Journal Trauma, 2005, 59(5):1219–1223.
8. Rennie L, Court-Brown C, Mok J, Beattie T. The epidemiology of fractures in children. Injury, August 2007, 38(8):913–922.
9. Wheeless CR (ed.) Wheeless’ Textbook of Orthopaedics. Data Trace Internet Publishing. Available at www.wheelessonline.com
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The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
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