Management of finger injuries begins with closed reduction of the fracture or dislocation, if indicated. In one study, alltType A fractures were stable, whereas 17% of type B fractures and 42% of type C fractures showed subsequent displacement. Reference article, Radiopaedia.org (Accessed on 01 May 2023) https://doi.org/10.53347/rID-76833. She was started on a home exercise program at that time. On the lateral view, the distal ulnar epiphysis is largely obscured by the distal radius. Distal phalanx fractures are often seen following crush injuries of the fingertips at home or in the work-place. The capitellum and radiocapitellar joint are best seen on the radiocapitellar view. The chronologic order of appearance of elbow ossification centers is as follows: capitellum, radial head, medial epicondyle, trochlea, olecranon, and lateral epicondyle at 1, 5, 7, 10, 10, and 11 years, respectively. In addition, usually, the trochlea initially appears as multiple fragmented ossification centers; by contrast, the medial epicondyle has a smooth and regular appearance. Philadelphia, PA: Wolters Kluwer/Lippincott, Williams & Wilkins; 2010. Master Techniques in Orthopaedic Surgery: The Hand. In children younger than 5 years, the annular ligament is relatively loose, allowing the radial head to be pulled through it when acute traction is suddenly placed on a pronated forearm (which is the usual position of the forearm when a child is being pulled along by an adult). Splinting in extension for two to three weeks is the typical nonoperative treatment. Ratti C, Guindani N, Riva G, Callegari L, Grassi FA, Murena L. Musculoskelet Surg. These deformities may cause posttraumatic arthritis with pain and diminished range of motion, which are often not correctable. [9, 10, 11], A review of medical records of 462 children (median age, 6 yr) with elbow fractures identified the most common fractures as supracondylar (N=258, 56%), radial neck (N=80, 17%), and lateral condylar (N=69, 15%). Additionally, it is the orientation of the neck rather than the shaft that should be used to evaluate radiocapitellar alignment. WebTransphyseal fractures of the distal humerus typically occur in children younger than 3 years secondary to birth trauma, nonaccidental trauma, or a fall from a small height. Transcondylar fracture with typical posterior and medial displacement of the distal fragment. This fracture at the fingertip is often associated with a crush Appointments 216.444.2606 Appointments & Locations Medial epicondyle fracture with entrapment in an 8-year-old boy. Fig.1. Babal JC, Mehlman CT, Klein G. Nerve injuries associated with pediatric supracondylar humeral fractures: a meta-analysis. Distal CRPP is a common technique to manage these injuries and is usually performed in the operating room (OR) setting using Kirshner wires (k-wires) under local anesthesia or a peripheral nerve block. 25 (3): 527-42, vii-viii. [16], Tokarski et al found that use of conventional radiography may be reduced in patients with a low clinical concern for fracture and normal elbow ultrasound. Distal phalanx fracture. This site needs JavaScript to work properly. Although only a very thin sliver of bone may be viewed, it represents the small ossified portion of the entire distal fragment that is mostly cartilage (see the image below). It is normal for your finger to be a bit achy and swollen for a couple of months after this type of injury. JB Lippincott. See the image below. your express consent. This is sometimes called a tuft fracture Healing: This normally takes approximately 4-6 weeks to heal. Reproduced with permission from Soyer AD: Fractures of the Base of the First Metacarpal: Current Treatment Options. 2008 Feb. 24(1):139-52. Open Fracture Reduction 2019 Feb 1;13(1):47-56. doi: 10.1302/1863-2548.13.180156. MRI is useful in identifying medial epicondyle fractures prior to ossification of the medial epicondyle and for delineating the full extent of the cartilaginous fracture in children with a small medial epicondyle ossification center. This content is owned by the AAFP. The rare Salter-Harris type II may mimic lateral condyle fracture radiographically, but not clinically. Demonstration of normal alignment between the proximal radius and the capitellum (radiocapitellar line) and normal alignment of the proximal radius and ulna with each other are the keys to differentiating transphyseal fracture from elbow dislocation. Radiocapitellar alignment remains normal. However, the trochlea does not become ossified before the medial epicondyle. This website also contains material copyrighted by 3rd parties. Chicago, IL: Year Book Medical Publishers, Inc; 1985. Case Report: Locking Plate for Cubitus Varus Correction in a 7-Year-Old Girl With Osteogenesis Imperfecta. Although not directly analogous, this is one example of the cost disparities associated with performing a procedure in the ER versus OR. Herman MJ, Boardman MJ, Hoover JR, Chafetz RS. Lateral condyle fracture with instability. Nerve injuries may complicate supracondylar fractures. Radiographic evaluation with a minimum of three views (commonly anteroposterior, true lateral, and oblique) is required if any fracture or dislocation is suspected.4. [QxMD MEDLINE Link]. Cepela DJ, Tartaglione JP, Dooley TP, Patel PN. See Instructions for Authors for a complete description of levels of evidence. [QxMD MEDLINE Link]. J Bone Joint Surg Am. Anteroposterior view shows a mildly abnormal angular configuration of the lateral aspect of the proximal radial metaphysis. Transphyseal fracture (also called transcondylar fracture) is a fracture through the distal humeral physis that separates the entire distal humeral epiphysis from the metaphysis. If an associated radial fracture is not identified, a careful search should be made for a radiocapitellar dislocation or subluxation. Clinical features that suggest a medial condyle fracture include instability and a limitation of elbow motion. Federal government websites often end in .gov or .mil. [5] Because supracondylar fractures may be oriented obliquely on the lateral view, coursing proximally from anterior to posterior, an AP view with cephalad angulation of the x-ray beam may help to better demonstrate such a fracture. Beaty JH, Kasser JR. Rockwood and Wilkins' Fractures in Children. J Bone Joint Surg Am. A local joint block can be considered if significant pain impedes reduction. Non-accidental Trauma Results of a three-dimensional computed tomography analysis. Phalangeal Fractures Treatment & Management: Fractures of the Abnormality of the anterior humeral line indicates distal humeral deformity and, therefore, either an acute or previous fracture. In this case, the lateral crista is part of the distal fracture fragment, leading to instability of the elbow joint. Although it is important to differentiate medial condyle fractures from medial epicondyle fractures, the distinction is not always easy to make with radiographs. A nondegenerative injury was seen in 27.5%, and 67.9% were degenerative injuries. [QxMD MEDLINE Link]. Fracture of the medial condyle is an uncommon injury in children. 3rd ed. The most common fracture seen is a tuft fracture. A variety of treatment modalities exist for distal phalanx fractures including closed reduction and splinting, closed reduction and percutaneous pinning (CRPP), and open fixation. Both direct and indirect findings are helpful in the radiographic diagnosis of supracondylar fractures. Medial epicondyle fractures are 3 times more common in boys than girls and tend to occur in older children more often than supracondylar or lateral condyle fractures, with a peak age of 11-12 years, although younger children may also be affected. 2015 Aug 28. 1) and a protective splint was placed. Distraction may also result from the ulnar collateral ligament with elbow dislocation or subluxation, which accounts for approximately half of medial epicondyle fractures in children. Finger fractures involving greater than 30 percent of the intra-articular surface should be referred to an orthopedic or hand surgeon. Salter-Harris IV injuries typically have a poor prognosis due to interruption of the proliferative and reserve cartilage zones often leading to altered joint mechanics and functional impairment and as such orthopedic evaluation and subsequent operative intervention are often required 1,2. These fractures are commonly classified as intra- or extra-articular. The pin was removed at her 6-week follow-up, at which time there was some early consolidation of the fracture on imaging. A Monteggia variant has fractures of the radius and ulna. In the absence of associated microvascular injury, most fractures can be stabilized nonurgently and subsequently scheduled for surgery on an outpatient basis. Functional outcome of the elbow in toddlers with transphyseal fracture of the distal humerus treated surgically. These fractures usually have anterior displacement of the distal fragment. Anteroposterior view shows disruption of the medial cortex. Salter-Harris type IV fracture | Radiology Reference Article The articular portion of the ulna is formed by the olecranon process proximally and by the coronoid process more distally. 1990. Distal Phalanx Fractures Some error has occurred while processing your request. [13] In astudy of 900 young baseball players (aged 7-11 yr), 35.2% reported episodes of elbow pain. (A) On the anteroposterior view, the fracture is seen as a longitudinal lucent line through the medial aspect of the proximal ulna. Please confirm that you would like to log out of Medscape. It is also referred to as the terminal phalanx. The mean annual incidence was 0.8 per 105. This motion causes the ulna to fracture and contact the proximal radius, forcing the radial head to become dislocated from the capitellum. See the image below. Fractures and dislocations of the elbow region. J Emerg Med. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2020 Dec 1;15(1):575. doi: 10.1186/s13018-020-02118-2. Jpn J Radiol. doi: 10.1007/s12306-015-0366-z. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Many pediatricians and emergency physicians are not as familiar with these fractures as they are with supracondylar fractures, and some lateral condyle fractures may be subtle. This technique has not been previously described in the Orthopedic literature for diverse pattern of fractures of the distal phalanx. During that time, you will need regular X-rays to ensure that the bone has not slipped out of alignment. After spontaneous reduction, prior elbow dislocation may be suggested by the identification of the fractures described above. Anteroposterior (A) and lateral (B) views. Wolters Kluwer Health, Inc. and/or its subsidiaries. Front Pediatr. Very specific fractures for NAT. Features that help in distinguishing between transphyseal and lateral condyle fractures include alignment of the radiocapitellar joint and the direction of displacement. Elhusseiny K, El-Sobky TA. 17.1 ). Rang M. Children's Fractures. Wedge JH, Robertson DE. Orthop Clin North Am. In supracondylar fractures with medial displacement of the distal fragment, there is often internal rotation, which results in varus if the fracture is oblique. distal phalanx fracture; percutaneous pinning; emergency department; hypodermic needle. Fracture 198:214-219.e2. Felix S Chew, MD, MBA, MEd is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, International Skeletal Society, Radiological Society of North AmericaDisclosure: Nothing to disclose. Although the annular ligament becomes transiently interposed between the radial head and capitellum, this movement does not cause recognizable widening of the radiocapitellar joint. Once the fracture has healed, it is very important to follow all therapy instructions to improve motion in the thumb. The rest of the radius appears dislocated with respect to the capitellum; however, this is a displaced fracture rather than a dislocation (see the image below). Okumura Y, Maldonado N, Lennon K, McCarty B, Underwood P, Nelson M. Point-of-Care Ultrasound: Sonographic Posterior Fat Pad Sign: ACase Report and Brief Literature Review. Medial condyle fracture with markedly rotated distal fragment in a 7-year-old boy. Yoong P, Goodwin RW, Chojnowski A. Phalangeal fractures of the hand. Philadelphia, PA: JB Lippincott; 1983. Our proposed technique would not deviate from that standard protocol. The peak age of occurrence for these fractures is 4-10 years. However, in most patients, the injury is caused by a fall onto a pronated forearm, which forces the arm into hyperpronation. Prognostic Level III. Hence, lateral condyle fractures are Salter-Harris type IV injuries, even though they often have the radiographic appearance of a Salter-Harris type II injury. Lateral (Monteggia type 3) injuries most often occur in children 5-9 years of age (see the image below). Edmonds EW. The anterior humeral line may be extremely useful in the diagnosis of supracondylar fracture. Displaced, oblique, or spiral fractures are inherently unstable and should be referred to a hand specialist.3. [29, 30] : Type 1 - Fractures with no or minimal posterior displacement or angulation of the distal fragment such that the anterior humeral line still intersects part of the capitellum, Type 2 - Fractures with more posterior displacement or angulation, but with an intact posterior cortex; type 2 fractures have been divided into type 2A, with no rotation or translation, and type 2B, with some rotation or translation in addition to posterior displacement and angulation, Type 3 - Fractures with displacement and complete cortical disruption (see the image below), Type 4 - Fractures with displacement, complete cortical disruption, and complete loss of the periosteal hinge anteriorly and posteriorly leading to multidirectional instability. Broken fingers generally heal well after treatment and rehabilitation. [41] : Stage I fractures have an intact articular surface. Check for errors and try again. 39(2):163-71, v. [QxMD MEDLINE Link]. Unable to load your collection due to an error, Unable to load your delegates due to an error. Entrapment of the medial epicondyle may be difficult to detect on the frontal view; such entrapment is often better depicted on the lateral view. Initial anteroposterior (A) and lateral (B) views show an obvious lateral condyle fracture and a relatively subtle olecranon fracture. encoded search term (Imaging in Pediatric Elbow Trauma) and Imaging in Pediatric Elbow Trauma. Screening was performed using low-magnetic-field (0.2-T) MRI. WebThe doctor will take an X-ray of the wrist. These may have some angulation but no true displacement of the fracture fragment and no shift of the olecranon. [QxMD MEDLINE Link].