Lateral condyle.pptx

Trauma conference supracondylar humerus fracture

1. TRAUMA CONFERENCE 10-28-22 Dr. Failagao, Nel John Roy Bereber Level 1 Resident

2. General Data: Name: Villanueva, Criyz Nikko Hosp No. 1168133 Age/Sex/CS : 6/M/ Ch Address : Dumangas , Iloilo

3. HISTORY NOI Fall TOI 5pm POI Dumangas DOI 10/16/22 Patient was playing when he fell on his outstretched hand thus sustaining his injuries 1 day PTA, patient sought consult at OPD and was advised for Admission. (+)Pain/Swelling/LOM of left elbow complex

4. Fracture Closed Complete Displaced Lateral Condyle Humerus , Left Secondary to Fall AO 13B1.1 Milch Type II Weiss type 3

5. PLAN For Close vs Open Reduction, Multiple Pinning of Lateral Condyle Left Approach: Lateral Approach to the Elbow Implants:K-wire 0.045/0.062

6. DISCUSSION T ransphyseal , intraarticular injuries Second most common operative elbow injury in children

7. ANATOMY

8. BLOOD SUPPLY Care must be taken to ensure that all soft tissue dissection occurs anteriorly to avoid the posterior blood supply of the distal fragment . Brachial artery; Anteriorly in the antecubital fossa-anastomotic vessels that course posteriorly

9. ANATOMY Extensors And Supinator Capitellum is the first secondary ossification center of the elbow to appear (~2YO) The lateral epicondyle is the last (12-13YO) Two ossification centers fuse at skeletal maturity

10. MECHANISM OF INJURY Elbow is forced into varus Valgus force in which the radial head directly pushes off the lateral condyle Extensor muscles and lateral collateral ligaments, applies an avulsion force to the lateral condyle Fracture line extends to the trochlear notch (bottom right), the elbow becomes unstable.

11. MILCH CLASSIFICATION   TWO GROUPS DEPENDING ON THEIR RELATIONSHIP WITH THE  TROCHLEAR GROOVE Type II Fracture line is lateral to trochlear groove (less common, elbow is stable as fracture does NOT enter trochlear groove) Type II Fracture line extends medially into trochlear groove (more common, more unstable)

12. JAKOBS CLASSIFICATION

13. WEISS’S CLASSIFICATION < 2mm, indicating intact cartilaginous hinge Tx : Casting > 2 mm < 4 displacement, intact articular cartilage on arthrogram Tx : Closed reduction and fixation 4 mm, articular surface disrupted on arthrogram Tx : Open reduction and fixation

14. COMPLICATIONS The most common complications after lateral condyle fracture : Cubitus Varus Lateral Spur Formation Delayed Union Nonunion With Or Without Cubitus Valgus Growth Arrest Fishtail Deformity Of The Distal

15. Delayed Union M inimally displaced fracture that does not heal with 6 weeks of immobilization Untreated fracture that is initially seen more than 2 weeks (but by convention <3 months) after the injury.

16. Delayed Union and Nonunion Several factors contribute to the difficulty in achieving union of lateral condyle fractures . Fracture is intraarticular and thus is constantly exposed to synovial fluid. L ateral condyle has a poor blood supply If not immobilized, there is constant motion at the fracture site from the pull of the wrist extensors on the distal fragment.