National Library of Medicine Anteroposterior views of the injured left elbow (A) compared with the uninjured right elbow (B). Radiographic findings of elbow dislocation. This content is owned by the AAFP. Elbow dislocations are usually readily apparent on radiographs. Intra-articular fractures are often complicated and unstable and should be referred to a hand specialist.3 Extra-articular fractures may be nondisplaced or displaced. These injuries are due to valgus rather than varus stress and distract the physis starting medially. WebThe distal phalanx and proximal phalanx connect via the interphalangeal (IP) joint, which allows you to bend the tip of your thumb. While transphyseal distal humerus fractures are rare, the true incidence may be Abnormality of the anterior humeral line indicates distal humeral deformity and, therefore, either an acute or previous fracture. We describe 2 patients treated with this technique at our institution: 1 child with an open fracture dislocation of the distal phalanx and 1 adult with an open transverse fracture of the distal phalanx. (A) Note the avulsion of the medial epicondyle, which projects just distal to the trochlea on the anteroposterior view. ("Articular" means "joint.") As in all cases of trauma, the importance of recognition of open distal phalanx fractures is due to the increased risk of contamination and, hence, infection. J Pediatr Orthop. Pediatric Phalanx Fractures 2017. Song KS, Kang CH, Min BW, Bae KC, Cho CH. Initial anteroposterior (A) and lateral (B) views show a nondisplaced lateral condyle fracture. These fractures may be subtle and have only a linear lucent line through the trabecular region, as shown in the image below. Please enable scripts and reload this page. The peak age is 5-7 years, and the nondominant arm is involved more frequently than the dominant arm. Rather, only deformity is observed, as demonstrated by the anterior humeral line. Jpn J Radiol. Several types of fractures can involve the phalanx or the intra-articular surface. Peterson JJ, Bancroft LW. In young children in whom the distal humeral epiphysis is not yet ossified, this malalignment of the forearm bones and the distal humeral metaphysis may be mistaken to indicate an elbow dislocation. Although it is important to differentiate medial condyle fractures from medial epicondyle fractures, the distinction is not always easy to make with radiographs. [24], Complications of medial epicondyle fracture. [Full Text]. JAMES R. BORCHERS, MD, MPH, AND THOMAS M. BEST, MD, PhD. J Bone Joint Surg Am. If the capitellum is not yet ossified and hence cannot be used to evaluate elbow alignment, the direction of displacement of the forearm bone relative to the distal humeral metaphysis may be useful in distinguishing transphyseal fracture from elbow dislocation. Fredric A Hoffer, MD, FSIR Affiliate Professor of Radiology, University of Washington School of Medicine; Member, Quality Assurance Review Center Olecranon fracture. In young patients, alignment of the radiocapitellar joint is evaluated by using the radiocapitellar line, whereas in the more mature skeleton, articulating surfaces of the radial head and capitellum are revealed directly. Finger dislocations should be reduced as quickly as possible and concurrent soft tissue injuries treated appropriately. Carpenter S, Rohde RS. (A) Anteroposterior view shows vertically oriented fracture separating the medial and lateral condyles. Accessibility Sometimes, thumb fractures can result in joint instability when they involve the important ligaments that keep the joints aligned. Common Finger Fractures and Dislocations | AAFP The distal phalanx and proximal phalanx connect via the interphalangeal (IP) joint, which allows you to bend the tip of your thumb. These fractures are [QxMD MEDLINE Link]. The age at which ossification centers are first seen varies considerably; maturation usually proceeds earlier in girls than in boys. Copyright 2012 by the American Academy of Family Physicians. See the image below. In the series by Jakob et al involving 48 patients with lateral condyle fractures, 20 patients had fractures that were minimally displaced; 28 patients had significant displacement that required surgical reduction and fixation. Rogers LF. Some transphyseal fractures include a small portion of the metaphysis as shown in the image below; such a finding is helpful in recognizing that a fracture is present. 39(2):163-71, v. [QxMD MEDLINE Link]. See Instructions for Authors for a complete description of levels of evidence. Rogers LF, Malave S Jr, White H, Tachdjian MO. A 4-year-old child with medial epicondyle fracture. [QxMD MEDLINE Link]. In most cases, neurological deficit recover in a few months. Supracondylar fractures usually extend transversely across the metaphysis, whereas lateral condyle fractures are oblique and more distal. [Simple elbow dislocations in children : Systematic review and meta-analysis]. Fractures J Bone Joint Surg Am. Shaw BA, Kasser JR, Emans JB, Rand FF. Although the anterior fat pad may be seen without an effusion, it should not be elevated to this degree. Displaced, oblique, or spiral fractures are inherently unstable and should be referred to a hand specialist.3. Richard M Shore, MD Professor, Department of Radiology, Northwestern University, The Feinberg School of Medicine; Head, Division of General Radiology and Nuclear Medicine, Ann and Robert H Lurie Children's Hospital of Chicago A volar dislocation (Figure 2) can be accompanied by avulsion of the central slip extensor mechanism of the PIP. (B) On the frontal view, radial tuberosity is clearly recognizable. This typically occurs several years after the injury. The needle should be advanced across the DIP into the middle phalanx and this position should be confirmed with the mini c-arm. WebYou have broken your distal phalanx (the end of your finger). Pathy R, Dodwell ER. Initial anteroposterior (A) and lateral (B) views show a nondisplaced lateral condyle fracture. Digital blocks are readily performed in the ER and typically provide adequate anesthesia for this procedure. Transphyseal fractures of the distal humerus typically occur in children younger than 3 years secondary to birth [28] With greenstick fractures, cortical disruption is seen on the tensile side (usually the anterior cortex), and they may be accompanied by cortical buckling of the compression side (usually the posterior cortex). Successful relocation produces immediate relief of discomfort and resolution of the deformity. J Pediatr Orthop. [QxMD MEDLINE Link]. (2013) Hand clinics. The technique is cost and time effective when treating patients with this type of injury. [42] Distinction between lateral condyle fracture and transphyseal fracture is discussed in that section.
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