Musculoskeletal case studies for medical students

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History A 5 year old boy fell out of a tree. His left elbow was markedly swollen. His radial pulse was palpable and he was neurologically intact.
Initial X ray
Description AP X ray left elbow.
X ray
Description Lateral X ray
Problem The 5 year old boy who fell out of a tree and presented with a swollen left elbow.
X ray after treatment
Description X ray immediately after closed reduction.
Post management further view
Description Xray 2 months later.

Supracondylar fracture of the left distal humerus.

The capitellum should be on a line drawn down the anterior humeral shaft. In this case the distal humerus is displaced posteriorly. This means a reduction is needed.

Discussion of management

Under general anaesthesia a closed reduction was done. More than 90 degrees of elbow flexion was possible and the radial pulse remained palpable in this position. A backslab was applied for immobilisation.

If the radial pulse disappears after flexing the elbow, percutaneous kwires may be neceaasry to stabilise the fracture. It can then be immobilised in a more extended position that allows better perfusion (a position where the radial pulse is again palpable). Dunlop traction is an acceptable alterative to percutaneous K wires. If this is used, a second reduction, after a few days to allow swelling to subside, will probably allow easy reduction.


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