Pediatric Elbow Dislocation in Children


Pe Elbow Dislocation in Children

There are five conditions connected to elbow dislocations in children: pediatric elbow dislocation, pulled elbow (nursemaid’s elbow), congenital dislocation of the radial head, monteggia fracture, and transepiphyseal separation of the distal humerus. dislA pediatric elbow dislocation by itself occurs in older children between 10-15 years old. It is rare before the age of 3, and it is not a very common injury. The elbow dislocation is usually posterolateral.There is no relationship between the radial head and the capitellum, but you maintain the relationship between the radius and the ulna, so it is an elbow dislocation and not a Monteggia. The treatment of the pediatric elbow dislocation is closed reduction and early range of motion. This condition may have an associated medial epicondyle fracture.  Check if the medial epicondyle fracture is entrapped in the joint or not. The joint will appear incongruous. This fragment may be hard to detect especially if there is a spontaneous reduction of the elbow by itself. After reduction, if the fragment is still in the joint or if there is substantial fragment displacement, this is an indication for surgery (ORIF). Pulled elbow, or nursemaid’s elbow, is a common injury in young children between the ages of 2-3 years old. When pulling the child’s arm, the child goes in one direction and the parent goes in another direction, causing the annular ligament to become torn and trapped inside the joint and the radial head may be sublexed. This is not an elbow dislocation. It is a pulled elbow where the child refuses to move the elbow and the position of the arm of the child will be slightly flexed but pronated. When you get the x-rays, the x-rays are negative. It can be treated by reduction. elbowIt should be reduced by full supination of the arm followed by flexion and there will be no need for immobilization of the arm, let the child use the arm. In order to test if the elbow is reduced, you should give the child a piece of chocolate or candy. If the child can bend the elbow (flex the elbow) so he can have the piece of chocolate in his mouth, then that elbow is reduced. Congenital dislocation of the radial head is usually bilateral, and you can’t reduce it. There will be no significant history of trauma and the capitellum looks hypoplastic. You will find that there is posterior dislocation of the radial head, and the radius is bowed and shortened. You should check for other anomalies and if the condition is symptomatic, you will do radial head resection in adulthood. Monteggia fracture is a proximal 1/3 ulnar fracture and radial head dislocation or subluxation. The condition may be difficult to diagnose, and if the diagnosis is delayed, then the treatment will be complicated, and there will be more complications. Make sure that there is not a posterior interosseous nerve injury. The diagnosis is difficult because the fracture of the ulna may not be very apparent, but you have to look at the radial head position in relationship to the capitellum. The most common type of Monteggia dislocation is anterior dislocation of the radial head (check the relationship of the radial head and the capitellum. In Monteggia fracture, the radial head is the one that is dislocated and not the elbow. The relationship between the radial head and the ulna is also interrupted. If you do not get anatomic alignment of the ulna, the radial head may continue to sublex, and the ulna will heal in a bad position with the radial head dislocated. This condition will need osteotomy of the ulna and open reduction of the radial head. Differentiating pediatric elbow dislocation from transepipyseal separation of the distal humerus can be difficult. Because there is no clearly visible ossific centers at the distal humerus at the younger age, this condition can be misdiagnosed as an elbow dislocation. In pediatric elbow dislocation, the olecranon moves posteriorly and laterally. Pediatric elbow dislocation does not occur in children at 1 or 2 years old. Transepiphyseal separation of the distal humerus usually occurs in a younger age group than an elbow dislocation. The distal fragment goes medially. In transepiphyseal separation, you will find that the radiocapitellar line remains the same. When you have this condition of transepiphyseal separation of the distal humerus, consider child abuse, look for other signs of abuse.

Acetabular Fracture- Associated Both Columns

Acetabular Fracture- Associated Both Columns

Associated both column fracture is fracture of both columns of the acetabulum. Both columns are separated from each other and from the axial skeleton, resulting in a floating acetabulum. This is the most complex type of acetabular fracture. The fracture type used to be called “central acetabular fracture”. This fracture pattern may be associated with central dislocation and no part of the articular surface remains attached to the axial skeleton. The acetabular fragments become free and rotate around each other. They may appear to maintain congruity to the femoral head. There is dissociation of the articular surface from the axial skeleton. Because of this secondary congruity, traction may be used in the treatment of associated both column fracture in the elderly. You will see the “spur sign” above the acetabulum on the obturator oblique view and this is diagnostic for associated both column fracture. In the obturator view, you will find the anterior column (iliopectineal line) is disrupted and you will find the “spur sign”. The “spur sign” is the posterior inferior aspect of the intact posterior ilium. Another feature of the associated both column acetabular fracture is the Judet sign of the curved line. The Judet sign of the curved line occurs due to interruption by the fracture of the iliopectineal line. acxThe curved line belongs to the greater sciatic notch and if after fixation anteriorly, the patient has a positive curved line sign, then the posterior column is probably not reduced. The roof of the acetabulum is involved either totally or partially. When you see an x-ray and the roof of the acetabulum is in pieces, then this injury is probably an associated both column fracture. You will see a coronal plane fracture through the iliac wing. In general, see Coronal for Column fracture. If you have both column fracture and there is an additional fracture going to the ilium, then this is an associated both column fracture. In CT scan, the fracture will be coronal. T-shaped fracture of the acetabulum is different from an associated both column fracture of the acetabulum. In associated both column fracture of the acetabulum, the fracture goes through the ilium. The acetabulum is floating and is disconnected from the axial skeleton. If you see extension of a transverse fracture of the acetabulum through the medial wall of the acetabulum and the fracture is going through the obturator ring, then this is a T-shaped fracture. The ilioinguinal approach is the main approach used to treat associated both column fractures.

What is a Ganglion Cyst?

What Is A Ganglion Cyst- Everything You Need to Know

A ganglion cyst is a benign cyst that is filled with a jelly-like fluid. Ganglion means a “knot”. It is not a malignant tumor; it is just a soft tissue mass. Ganglion cysts are not cancerous and will not spread. This mass may change in size, and it may grow slowly. Ganglion cysts usually do not cause any harm and if the patient finds it, the patient is usually more concerned about how the cyst looks. gcThese cysts can put pressure on the nerves, vessels, and tendons which can cause problems for the patient. Ganglion cysts can occur anywhere. They usually occur at the wrist area, however ganglion cysts may occur at the foot (usually at the top of the foot). Ganglion cysts can occur around the shoulder, around the knee, or even occur in the bone itself. Ganglion cysts around the foot or the wrist will usually transilluminate because it is not a solid cyst; there is fluid inside the ganglion cyst. Ganglion cysts will transilluminate.

Treatment of Ganglion Cysts

Ganglion cysts that do not bother the patient are usually left alone. Aspiration will decompress the ganglia and decrease the pressure on the adjacent structures. Surgery is done as a last resort to treat ganglion cysts. It is usually done when the ganglion cyst causes the patient pain or harm such as pressure being placed on the nerves, vessels, and tendons.

Anatomy of the Rectus Femoris Muscle

Anatomy of the Rectus Femoris Muscle

The rectus femoris is the anterior muscle of the quadriceps femoris. The quadriceps femoris is a group of four muscles on the anterior thigh. The rectus femoris muscle lies in front of the vasti muscles. The rectus femoris muscle arises from the pelvis, the other muscles of the quadriceps arise from the femur. rThe rectus femoris has two heads originating from the pelvis: the straight head and the reflected head. The straight head arises from the anterior inferior iliac spine of the pelvis. The reflected head originates from a groove superior to the acetabulum. The rectus femoris muscle is inserted into the superior border of the patella through the quadriceps common tendon. This muscle flexes the thigh at the hip, and it extends the knee. This muscle flexes the thigh at the hip and it extends the knee. If the muscle crosses the hip anteriorly, then it flexes the hip joint. This muscle flexes the thigh at the hip, and it extends the knee. This function advances the lower extremity in walking. The rectus femoris muscle helps in kicking the ball with sports such as soccer, and it could be injured during this function. Tears or strains of the rectus femoris muscle can occur and can be an acute process from forcible eccentric contraction of the rectus femoris muscle. These injuries are usually more distal on the thigh or near the knee. In adolescent patients, there may be an avulsion fracture of the anterior inferior iliac spine because it is weak. In adolescents, if you see a piece of bone near the hip joint, this is a sign of pulled rectus femoris muscle. Treatment is usually rest with crutches, not surgery.