Case presentations

Upper limb
A 10 years old girl, fell off while playing the football

MUA and casting was performed

 30 month old female. Fell when
playing on bed. Complaining of left
elbow pain. Decreased ROM. ?
Fracture?
Supracondylar fracture, Gartland 1

 Incomplete supracondylar
fracture seen on the ulna aspect
of the distal humerus with bony
irregularity noted.

 Large associated joint effusion

with elevation of both fat pads.
A 9 y.o boy fell off the sling on outstretched
hand.
Extension type of supracondylar humeral fracture
type 3 Gartland.
MUA and K-wiring was performed with satisfactory
results.
A 8 y.o boy fell off monkey bar.
Rare type of supracondylar fracture- flexion type.
Treatment

 MUA and K-wiring was

performed
K- wires were removed after 6 weeks.
The outcome was satisfactory.
 6 year old girl with deformed right
elbow since a fall today
 Large effusion.
 Supracondylar fracture
extending to the dorsal
surface of the distal
humerus and also a
fracture extending
throught the lateral
condyle involving the
capitellum.
 (Salter Harris IV)
MUA and K-wiring performed with good results
 Gartland classification

Urgent orthopaedic
Collar and cuff Reduce, above elbow assessment and
cast + orthopaedic theatre
review
A 3 yo boy sustained a lateral condylar fracture on
playground.
MUA and K-wiring was performed
A 10 years old girl fell at school during gim
classes
Monteggia fracture was diagnosed.
MUA+ ORIF of ulna, Metaizeau technique was used to
reduce the radial head.
Monteggia fracture
 Ulnar shaft fracture and radial head dislocation
 Rare – only 2% of elbow injuries
 Mechanism is usually hyperextension at the
elbow
 Isolated ulna injuries are rare.. Examine and x-
ray the joint above and below
 The posterior interosseous nerve is the most
commonly affected – deep extensor muscles
 Requires immediate orthopedic referral
 8 year old boy fell playing basketball
 Salter Harris II fracture
of the base of the
proximal phalanx of
the little finger.
 MUA + immobilization
was performed
 5 years old fell onto thumb whilst on
bouncy castle
 Transverse fracture at the
base of the proximal phalanx
of the left thumb, extends
into the physis,
 Salter Harris II,
 30 degrees of radial
angulation

 MUA+ thumb spica cast

A 14 year old boy sustained the injury of middle
phalanx of the right index finger. His finger got
caught between handlebars of the bicycle.
MUA and K-wiring was performed
Lower limb
Case presentations
A-14 years old boy, football injury
Compartment syndrome watch!
CT scan: avulsion fracture of tibial
tuberosity and tibial plateau fracture

The canulated screw was used to stabilize the fracture

Ankle fractures in children
Tillaux fracture
Triplane fracture 2 and 3
parts
A 14 y.o boy, trampoline injury.
S-H type IV
ORIF with canulated screw was performed.
Method of fixation

 Screws
Method of fixation

 Screws
 9 year old who fell off skateboard
 Presents with swelling to the left
ankle and unable to weight bear
 Previous fibular fracture
Management

 Undisplaced Salter-Harris II fractures

of the distal tibia: non weight
bearing below knee plaster back slab
+ follow up in 7 days
 7 year old fell from play equipment
 Swollen right ankle
 Non weight bearing
 The anterior and posterior
recesses of the ankle joint
(arrowed) are of fluid density
and suggest the presence of a
large ankle effusion.

 The age-group, the soft tissue

swelling, the inability to weight-
bear and the ankle effusion
suggest a significant force and
raise the possibility of a Salter
Harris I injury to the distal
fibular growth plate.
 Salter Harris I
 Most common and most
missed
 Diagnosed clinically
 Tenderness over fibula
physis (as opposed to
tenderness over the ATFL)
+/- swelling
 X-ray may be normal or
there may be swelling
laterally
 11 year old boy with swollen painful
right ankle since a fall today
Fracture of the medial
mallelous extending to the
physis suggesting a Salter
Harris III.

Widened ankle mortise

medially. Possible lateral
malleolar Salter Harris II
fracture.
 13 year old, externally rotated ankle
 Pain on weight bearing
Tillaux
 Salter Harris III of the distal tibia – avlusion
of the anterolateral part of the epiphysis

 If non displaced can be managed with

below knee back slab.

 CT needed to confirm non displacement –
displaced fractures require an operation
 10 year old boy who inverted his foot
and presents with pain at the base of
the fifth metatarsal
 Complication

 Malunion is not usually a problem (except cubitus

varus)
 Nonunion is hardly seen (except in lateral condyle of
humerus)
 Growth disturbance – epiphyseal damage
 Vascular - Volkmann’s ischemia
 Infection - rare
 Its good to be young…

 Fractures in children may stimulate longitudinal growth –

some degree of overlap is acceptable and may even be
helpful.

 Children don’t tend to get as stiff as adults after

immobilization.
Good bye!