Noon Conference

Ext. Wittawat Kittivisuit

History

• A Thai 6 years old boy fall from height 4 hr PTA. There is no history of head trauma, no amnesia, no lucid interval. After falling he can stand up by his own and no weakness. He has pain at left elbow and deformity. He can’t move his left arm because of the pain but there is no numbness all distal to deformity

NORMAL

Secondary Survey

Film

Diagnosis

?

Lateral Condyle Fracture Jakob II

Set OR for Close Reduction and External Fixation with

K-wire with Posterior Long Arm Slab

Treatment

• Nonoperative long arm casting– indications• only indicated if < 2 mm of displacement, which

indicates the cartilaginous hinge is most likely intact• sub-acute presentation (>4 weeks)

– technique• cast with elbow at 90 degrees and forearm supination• weekly follow up• total length of casting is 3-7 weeks

Treatment

• OperativeClose reduction with percutaneous pin fixationindications• somewhat controversial, but Weiss et al suggest

fractures with < 4 mm of displacement have intact articular cartilage and can be treated with CRPP

Treatment

• Operative(cont) Open reduction and fixationindications– if > 2-4mm of displacement– any joint incongruity – fracture non-union

Complication

• Nonunion• AVN• Malunion- cubitus valgus due to growth arrest• Tardy ulnar nerve palsy• Growth arrest

For GP

• Just divide to two group Jakob I and not Jakob I• Not Jakob I refer• Tardy ulnar palsy can occur after fracture 10-20

years don’t forget about history of trauma can lead to deformity and nerve palsy in the future

• If unsure on slab and follow up film next week fracture line can see crystal clear if there is fracture

Thank