WhiteCoat

What’s The Diagnosis #4

A 13 year old boy comes in after being thrown from an ATV while riding in a field. His arm is painful and deformed at the elbow. He has numbness in his thumb, index, and middle fingers.

What is the diagnosis? What problems do you have to worry about? What should you monitor? What is his prognosis?

Scroll down for the answer.

Supracondylar Fracture

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Answer: Type III Supracondylar Elbow Fracture

With sensory deficit in the first three fingers of the hand, the patient likely has a median nerve injury. Also note the darker grey fat pad immediately posterior to the distal fracture segment.

Gartland Classification of Supracondylar Fractures includes
Type I: non-displaced
Type II: displaced, but with intact posterior cortex
Type III: displaced with complete dissociation of fracture segments

Vascular compromise occurs in up to 20% of children with supracondylar fractures. If missed, can develop compartment syndrome or ischemic contractures.
Compartment syndrome occurs infrequently and may be difficult to diagnose in presence of an associated median nerve palsy since the pain associated with compartment syndrome is diminished. May consider applying a continuous pulse oximeter to help monitor perfusion.
Median nerve injury can occur in up to half of patients with Type III supracondylar fractures.
Radial nerve injury can occur in up to 25% of patients with Type III supracondylar fractures.
Supracondylar fractures can often be fixed by percutaneous pinning, but may require open reduction and/or exploration if vascular injuries or if unable to achieve satisfactory reduction using closed manipulation.
Neurologic deficits often, but not always, resolve in 3-6 months.
Range of motion in joint may not return for up to 12 months.

References:
Wheeless’ Textbook of Orthopaedics
Orthopaedia.com

4 Responses to “What’s The Diagnosis #4”

  1. DaveyNC says:

    I hate ATV’s. Morons on moronic devices. That looks unbearably painful

  2. Melanie says:

    Almost died twice on ATVs I REFUSE to ever ride one again. No thank you. Kids on ATVs are worse. Ugh.

  3. RSDS says:

    You also need to watch for Complex Regional Pain Syndrome (CRPS) also known as Reflex Sympathetic Dystrophy Syndrome (RSDS). I have it, hence my user name for commenting on medical blogs.

  4. Anonymous says:

    My non-medical guess was broken elbow (duh) with a nerve being pinched. In the xray the kid looks pretty muscular though but yeowch that must hurt.

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