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. Abzug JM, O'TYoole RV, Paryavi E, Sterling R. Are orthopaedic residents competent at performing basic nonoperative procedures in an unsupervised setting? Although the Baumann angle does not define the true carrying angle of the elbow, it uses radiographically identifiable landmarks and is useful in comparison with the contralateral elbow. (A) Anteroposterior view. A mini c-arm is utilized to help localize the distal tip of the distal phalanx on both the PA and lateral view. In addition, usually, the trochlea initially appears as multiple fragmented ossification centers; by contrast, the medial epicondyle has a smooth and regular appearance. [QxMD MEDLINE Link]. Fracture at the dorsal aspect of the base of the distal phalanx is commonly associated with palmar subluxation of the distal phalanx. Some error has occurred while processing your request. This fracture at the fingertip is often associated with a crush In some cases, the fracture may extend into the metaphysis, producing a Salter-Harris type II injury. These injuries are due to valgus rather than varus stress and distract the physis starting medially. An 18-month-old child with buckle-type distal humeral supracondylar fracture and an associated distal radial metaphyseal buckle fracture. Note associated proximal radial metaphyseal fracture. Barton KL, Kaminsky CK, Green DW, et al. In most cases, lateral condyle fractures are distraction injuries from the forearm extensors, usually as a result of acute varus stress applied to an extended elbow. Finger and metacarpal fractures are the most common sports-related fractures in adults and adolescents.1,2 If not treated properly, finger fractures and dislocations can have significant consequences, including poor function, chronic pain, stiffness, and deformity.3 The goal of management is return to normal function and activity. It is imperative that extension is maintained at all times during treatment because any flexion can affect healing and may extend the treatment period. This report describes 2 patients, 1 pediatric and 1 adult, with different injury mechanisms resulting in distal phalanx fractures treated successfully with bedside percutaneous pinning with a hypodermic needle in the ED. Rogers LF, Malave S Jr, White H, Tachdjian MO. When the cast is removed, your doctor may recommend hand therapy to restore movement to your hand. Note the pseudoarthrosis of the distal phalanx of the fourth toe Fig.3. Closed fractures are generally stable, especially when they do not involve the articular surface. The distal interphalangeal joint was swollen and tender with a loss of active movement. The pin was removed at her 6-week follow-up, at which time there was some early consolidation of the fracture on imaging. These fractures are (B) The ulnar fracture has apex lateral angulation and is well aligned on the lateral view. The risk of a thumb fracture can be lessened by using protective taping, padding, or other equipment. Pulled/nursemaid's elbow. Semin Ultrasound CT MR. 2018 Aug. 39 (4):384-396. Tokarski J, Avner JR, Rabiner JE. [41] Because the distal humerus has a broader base at the physis than in the region of the olecranon fossa where supracondylar fractures occur, there is more contact between the fragments, and hence less tilting. 2012 Jun;26(6):657-60. In cases in which the radial head is not yet ossified, this injury cannot be distinguished from a true Monteggia fracture/dislocation by use of plain radiographs. 2021 Jul;31(5):871-881. doi: 10.1007/s00590-021-02932-2. 2010 Apr-May. Fractures of the medial epicondyle account for 10-15% of elbow fractures in children. J Pediatr. Reduction is often successful without anesthesia. Reduction may be unsuccessful because of soft tissue injury or fracture. Radial head displacement or injury to the proximal radial growth plate may cause growth arrest, leading to radial shortening that may affect alignment of the wrist. Copyright 2012 by the American Academy of Family Physicians. [QxMD MEDLINE Link]. Fracture Nonoperative treatment for Distal phalanx, distal and Although the Baumann angle usually is defined as the angle between the growth plate for the capitellum and a line drawn perpendicular to the humeral shaft, the need to draw the perpendicular line can be avoided by using the complement of the angle between the capitellar growth plate and the humeral shaft. Fractures of the lateral condyle are the second most common elbow fracture in children, accounting for 15-20%. Finger dislocations can occur at the distal interphalangeal (DIP), proximal interphalangeal (PIP), or metacarpophalangeal (MCP) joints. Anteroposterior (A) and lateral (B) views. Anteroposterior (A) and lateral (B) views. Data is temporarily unavailable. Abzug, Joshua | University of Maryland School of Medicine The Difficult Supracondylar Humerus Fracture: Flexion-Type Injuries. Most common fracture of the hand. However, widening of the joint space may be difficult to evaluate in patients in whom the elbow is immature; in such cases, the largely cartilaginous trochlea makes the normal gap between the distal humerus and ulna appear quite wide. 295(6590):109-10. Anteroposterior (A) and lateral (B) views show significant lateral and posterior displacement of a distal fragment. Master Techniques in Orthopaedic Surgery: The Hand. encoded search term (Imaging in Pediatric Elbow Trauma) and Imaging in Pediatric Elbow Trauma. The capitellum (along with the remainder of the cartilaginous epiphysis) is medially and posteriorly displaced relative to the metaphysis. 474 (11): 2531-2537. A variety of treatment modalities exist for distal phalanx fractures J Pediatr Orthop. A unique physeal injury of the distal phalanx - PMC 2017 Feb 20. The olecranon apophysis fuses in an anterior-to-posterior direction; radiographs may reveal a residual posterior cleftlike lucency with well-defined sclerotic margins. [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). If the fracture extends into the joint, it is called an intra-articular fracture; if it does not, it is called an extra-articular fracture. Web26785 Open treatment of distal phalangeal fracture, finger or thumb, with or without internal or external fixation, each Depth of Plunge CPT Description 23515 Open treatment of clavicular fracture, with or without internal or external fixation 23615 Open treatment of proximal humeral (surgical or anatomical neck) fracture, with or