case report n°2 medical staff a&e 14/10/09 fvhospital dr. david tran
TRANSCRIPT
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Case report n°2
Medical Staff A&E 14/10/09FVHospital
Dr. David Tran
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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
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Xray of the right elbow
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Details of the right elbow Xray
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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
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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
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Xray of the right elbow 3 weeks after the trauma
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Xray comparison
J 0 J 21
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Xray comparison
J 0 J 21
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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
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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
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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
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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
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Basic rule in children’s elbow Xray
Radius axe
Condyle nucleus
Radius axe
Condyle nucleus