Ang Wan Wei, Overton Alexander, Ahmad Mudussar A
Department of Trauma and Orthopaedic Surgery, Whittington Hospital, London, N19 5NF, United Kingdom.
J Orthop Case Rep. 2020 Sep;10(6):64-67. doi: 10.13107/jocr.2020.v10.i06.1878.
Lateral condyle fractures and both bone forearm fractures account for 10-15% and 13-40% of all elbow fractures in children, respectively. About 5% of forearm fractures in children have associated supracondylar fractures; hence, any forearm fractures warrant a careful examination of the elbow, and any radiographs taken should visualize the elbow joint above and wrist joint below for other injuries. We report a case of multiple upper limb fracture in a child, comprising lateral condyle and both bone forearm fractures.
A 5-year-old boy was admitted through the emergency department at our district general hospital having fallen from a ladder approximately 1.5 m high in a playground. The limb was significantly deformed, with no evidence of an open injury, and remained neurovascularly intact throughout. Radiographs demonstrated a minimally displaced lateral condyle fracture of the left elbow, a midshaft ulna fracture, and a displaced off-ended distal third radius and ulna fracture of the left wrist. Any metabolic bone disease and non-accidental injury was ruled out. The patient was initially managed in an above elbow plaster cast, with elevation and monitoring for any neurovascular compromise. Computed tomography imaging was performed to completely assess the fracture pattern and for discussion with our local regional trauma center. Given the minimal displacement of the lateral condyle fracture, a conservative course of management was decided for this. The displaced distal radial fracture was managed with open reduction and internal fixation with a plate and the ulna shaft fracture with manipulation and plaster cast application. By 12 weeks after surgery, there was a full range of movement of the elbow, wrist, and forearm with complete radiological union.
This case emphasizes the importance of a secondary survey in the context of even minor trauma to rule out concurrent injuries. We found that minimally displaced lateral condyle fractures can be managed conservatively, and single-bone fixation in both bone forearm fractures can lead to very satisfactory outcome, with preference for plate and screw fixation for unstable fractures within the metaphyseal/diaphyseal junction.
儿童外侧髁骨折和双侧前臂骨折分别占所有肘部骨折的10% - 15%和13% - 40%。儿童前臂骨折约5%合并髁上骨折；因此，任何前臂骨折都需要仔细检查肘部，所拍摄的任何X线片都应包括上方的肘关节和下方的腕关节，以检查是否有其他损伤。我们报告一例儿童上肢多处骨折病例，包括外侧髁骨折和双侧前臂骨折。
一名5岁男孩通过急诊科入住我们地区综合医院，他在操场从约1.5米高的梯子上跌落。肢体明显畸形，无开放性损伤迹象，整个过程神经血管功能保持完整。X线片显示左肘部外侧髁骨折轻度移位、尺骨中段骨折以及左手腕桡骨和尺骨远端三分之一处骨折且骨折端移位。排除了任何代谢性骨病和非意外伤害。患者最初采用上臂石膏固定，并抬高患肢，监测有无神经血管受压情况。进行了计算机断层扫描成像以全面评估骨折类型，并与我们当地的区域创伤中心进行讨论。鉴于外侧髁骨折移位轻微，决定采取保守治疗方案。移位的桡骨远端骨折采用切开复位钢板内固定治疗，尺骨干骨折采用手法复位和石膏固定。术后12周时，肘关节、腕关节和前臂活动范围完全恢复，骨折完全愈合。
该病例强调了在即使是轻微创伤情况下进行二次检查以排除并发损伤的重要性。我们发现外侧髁骨折轻度移位可采用保守治疗，双侧前臂骨折中单骨固定可取得非常满意的效果，对于干骺端/骨干交界处的不稳定骨折，优先采用钢板螺钉固定。
