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May 2008 Radiology Quiz
This patient is a 6 year old female who presents to the ED with the complaint of left elbow pain. The patient staes she was running and fell down. The following xrays were taken.
Questions:
1. Describe what you see?
- Frontal, lateral and oblique views of the left elbow shows a suprcondylar fracture of the humerus with dorsal tilting of the distal fracture fragment.
- Diagnosis: Suprachondylar fracture
2. What is the mechanism of injury?
- The most common mechanism is a fall on the outstretched arm with the elbow in extension (indirect mechanism). In children the surrounding anterior capsule and collateral ligaments are stronger than the bone, and fractures rather than ligamentous tears usually result.
3. What would you find on physical exam?
- Recent injuries typically demonstrate little swelling with severe pain. The displaced distal humeral fragment can often be palpated posteriorly and superiorly because of the pull of the triceps muscle. As swelling increases, this injury can easily be confused with a posterior dislocation of the elbow resulting from the prominence of the olecranon and the presence of a posterior concavity. In addition, the involved forearm may appear shorter when compared with the uninvolved side.
4. How would you manage this patient?
- All supracondylar extension fractures require emergent consultation with an experienced orthopedic surgeon.
5. What are the complications?
- Distal humeral fractures are frequently associated with neurovascular complications, even in the absence of displacement. The most commonly injured structures are the median nerve and the brachial artery. In those fractures that are posteromedially displaced, neural compromise is more likely to occur
- Cubitus varus and valgus deformities are commonly seen in children. Malposition of the distal humeral fragment after reduction is the most frequent cause.
- Stiffness and loss of elbow motion are common complications in adults secondary to prolonged immobilization.
6. How is somatic dysfunction recorded by the physician: to the direction of ease or to the direction of dysfunction?
- Somatic dysfunction is always recorded to the direction of ease, the direction that the vertebra or dysfunctional joint can move most freely.
Trivia: Name the album and artist.
A: The Royal Scam by Steely Dan
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