Edited by Nattaly Greene, David Evans - 7/1/2021
Descriptors
- Second most common fracture pattern about the elbow in children accounting for 12-20% of all pediatric distal humerus fractures
- Usually happens due to fall from height onto outstretched arm
- Typically the fracture extends through lateral metaphysis into the epiphysis and often out through the articular surface
Exam Pearls
Patients present with swelling, ecchymosis, and tenderness to palpation to the lateral aspect of the elbow. Neurovascular compromise is uncommon with these injuries
Workup
Radiographs: AP, lateral, and internal oblique radiographs. Internal oblique views are helpful because the fracture fragment often displaces posterolaterally
Other imaging: CT is rarely utilized but can be helpful to better understand the fracture pattern preoperatively. Alternative imaging includes MRI and ultrasound which can be used to assess the integrity of the articular surface
Labs: No labs
Management
Need for acute intervention: Yes, immobilization without reduction
Degree of displacement dictates management
Less than 2mm displacement may be treated with cast immobilization
Greater than 2mm displacement with intact articular hinge may try closed reduction and pinning
Greater than 2mm displacement with disrupted articular surface is generally managed with open reduction and pinning
Weight-bearing and range of motion: Nonweightbearing of the affected extremity
Type of immobilization: Bivalved long arm cast with elbow flexed between 60-90 degrees. Casting for 4 weeks is usually sufficient for this injury
Admission or discharge status: Generally outpatient treatment
Anticoagulation: None
Antibiotics: None
Surgical Indications
Absolute: Open fracture, NV injury