Mohammad Ali Tahririan MD Department of Orthopedics Kashani Hospital

1. Distal Humeral Physeal Fractures Mohammad Ali Tahririan MD Department of Orthopedics Kashani Hospital

4. Classification

6. Mechanism of Injury

8. Signs and symptoms • Key: location of soft tissue swelling concentrated over the lateral aspect of the distal humerus. • Stage I: only local tenderness at the condylar fracture site, which may be increased by forcibly flexing the wrist. • Stage II or III: local crepitus with motion of the lateral condylar fragment.

11. Treatment

13. Percutaneous Pins

14. Open Reduction • If the fracture is grossly unstable, or satge III ORIF

17. Complications

18. Non union Treating is a difficult dilemma. Patients are usually asymptomatic except for those with high-demand athletic or labor activities. A mild flexion contracture of the elbow is present, but the cubitus valgus deformity is more cosmetic than functional. • No treatment progressive cubitus valgus deformity If surgery is performed, the potential risks of osteonecrosis and loss of elbow motion must be considered.

23. √√√ √

24. note

25. Lateral Spur Formation • Cotton believed that it is caused by coronal rotation of the distal fragment, which tends to displace the flap of periosteum associated with the distal fragment laterally. • This periosteum then produces new bone formation in the form of a spur.

26. The spur occurs after both nonoperative and operative treatment. • After nonoperativetreatment, • a smooth outline mild cubitusvarus/pseudovarus. • After operativetreatment • a more irregular outline and is usually the result of hypertrophic bone formation from extensive dissection

27. So • Before treatment of lateral condylar fractures, the parents may be told that either: • lateral overgrowth with mild cubitusvarus • Or • lateral spur • may develop, regardless of the treatment method. • They should be told that this mild deformity is usually not of cosmetic or functional significance

28. CubitusVarus

29. Dilemma ???

30. Cubitus valgus

31. Neurologic Complications

32. Osteonecrosis

35. Fractures of the capitellum involve only the true articular surface of the lateral condyle • Generally, this fragment comes from the anterior portion of the distal articular surface. • In adults, these fractures are not uncommon, but they are rare in children.

36. Classification

37. Mechanism of Injury

38. Treatment • If the fragment is: • large • acute • and if an anatomic reduction can be achieved with a minimum of open manipulation or dissection • ORIF • with two small cannulatedscrews from posterior to anterior through a lateral approach.

39. treatment • If the fracture is : • old • comminuted • or if there is little bone in which to engage the screw threads • simple excision

43. Mechanism of Injury

44. Mechanism of Injury

45. Classification More common

47. Diagnosis • Clinically and on radiographs, a fracture of the medial condylar physisis most often confused with a fracture of the medial epicondyle.

48. If the true location of the fracture line is questionable in a child younger than 8 to 10 years of age with significant medial elbow ecchymosis: • Arthrography or MRI

49. Treatment • Type I posterior splint • (Follow-up radiographs at weekly intervals are taken to ensure there is no late displacement.) • Types II and III ORIF

50. Complication • Both cubitusvarus and valgus deformities have been reported in patients whose fractures united uneventfully. • secondary stimulation or overgrowth of the medial condylar fragment Cubitus Valgus • decreased growth of the trochlea, possibly caused by a vascular insult Cubitusvarus