Pediatric Elbow Dislocation in Children

 

Pehttps://www.youtube.com/watch?v=IfcCTQtQFLkdiatric 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. A 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. It 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.