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A 6-year-old boy presents to the emergency room after falling off a trampoline and landing on his elbow. Examination reveals good radial and ulnar pulses, and a warm, pink, sensate extremity. Radiographs are shown in Figures A and B. He is taken to the operating room for fluroscopic-guided closed reduction and the surgeon creates a 2 pin construct. The fragment is anatomically reduced. He then notices that the pulses have disappeared and in spite of ambient warming and blood pressure elevation, are undetectable by doppler ultrasound for half an hour. The hand is paler and cooler than the contralateral side. What is the next best step?
Splint and observe postoperatively.
Remove the pins and perform closed reduction without internal fixation
Explore the brachial artery
Remove the pins and pin the fracture in the initial displaced position
Arteriogram evaluation of the brachial artery
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A 6-year-old presents with an elbow deformity after falling from the monkey bars. The skin is intact and no evidence of puckering is seen. The patient is neurovascularly intact. Representative radiographs of the injury are shown in Figures A and B. What is the optimal initial treatment for this injury based on the AAOS guidelines?
Closed reduction and casting
Primary open reduction and internal fixation
Closed reduction with medial and lateral crossed pins
Closed reduction with two or three lateral pins
A 6-year-old sustains the injury shown in Figures A and B. The nerve most commonly affected by this fracture pattern innervates which of the following motor groups?
Intrinsics of the hand
Thumb IP flexor
Figures A through E are injury radiographs of elbow injuries in children. A child complains of decreased sensation over the small finger acutely after an elbow injury. Which of the following radiographs is consistent with his injury?
A 7-year-old sustains the isolated injury shown in Figures A and B. On physical examination there is no evidence of soft tissue compromise and he is able to make an okay sign, give a thumbs up sign and cross his fingers. Which treatment will minimize complications?
Closed reduction with casting in > 90 degrees of flexion
Closed reduction with casting at 90 degrees of flexion
Closed reduction and a percutaneous pinning construct using laterally based pins
Closed reduction and a percutaneous pinning construct using crossed pins
Following successful operative treatment, routine removal of hardware is recommended at 3-4 weeks for which of the following procedures?
A 7-year-old patient presents with a fracture of her left supracondylar humerus and distal radius as evidenced in Figure A. She is neurovascularly intact and the skin shows no evidence of open wounds. Radiographs of the elbow show a displaced supracondylar fracture. Radiographs of the wrist show an extra-articular distal radius fracture with 25 degrees of dorsal angulation. This injury is most appropriately treated with which of the following?
Closed reduction and casting of the supracondylar humerus fracture and distal radius fracture
Closed reduction and pinning of both the supracondylar humerus fracture and distal radius fracture
Closed reduction and casting of the supracondylar humerus fracture and pinning of distal radius fracture
Open reduction and pinning of both the supracondylar humerus and the distal radius fracture
Closed reduction and pinning of the supracondylar humerus fracture and closed reduction and casting of distal radius fracture
A 9-year-old-female presents with her parents who have concerns regarding the appearance of her elbow (Figure A). Her past medical history is significant for a supracondylar fracture treated in a cast when as a younger child. She has no pain with motion and has 0 to 120 degrees range of motion. She does not have functional limitations but her parents would like to improve the appearance of her elbow. Which of the following procedures will correct the cubitus varus but may result in a lateral prominence?
Reverse V Osteotomy
Medial opening-wedge osteotomy with medialization of the distal fragment
Lateral closing-wedge osteotomy
Which of the following elbow apophyses is the last to fuse during growth?
External (lateral) epicondyle
Internal (medial) epicondyle
A child falls off of the monkey bars at school and sustains the left elbow injury shown in Figure A. What is a disadvantage of the fixation construct shown in Figure B compared to Figure C for this injury pattern?
Less biomechanical stability
Higher incidence of compartment syndrome
Higher chance of osteomyelitis
Higher risk of iatrogenic injury to the ulnar nerve
Higher risk of iatrogenic injury to the anterior interosseous nerve
A 7-year-old boy falls off the playground and sustains the injury shown in figure A. What motor deficit is associated with the nerve most commonly injured in this fracture pattern?
Weakness of the flexor digitorum profundus to the index finger
Weakness of the extensor pollicis longus
Weakness of the flexor pollicis longus
Hand intrinsic weakness
What is the advantage of medial and lateral crossed pins compared to two lateral pins in the treatment of supracondylar humerus fractures?
Greater ultimate clinical arc of elbow motion
Lower revision rate
Lower incidence of ulnar nerve injury
Greater experimental biomechanical stability
More anatomic fracture reduction
A 5-year-old boy sustained an elbow injury. Examination in the emergency department reveals that he is unable to flex the interphalangeal joint of his thumb and the distal interphalangeal joint of his index finger. The radial pulse is palpable at the wrist, and sensation is normal throughout the hand. Radiographs are shown in Figures 6a and 6b. In addition to reduction and pinning of the fracture, initial treatment should include
repair of the posterior interosseous nerve.
repair of the median nerve at the elbow.
neurolysis of the anterior interosseous nerve.
observation of the nerve palsy.
immediate electromyography and nerve conduction velocity studies.
Late surgical treatment of posttraumatic cubitus varus (gunstock deformity) is usually necessitated by the patient reporting problems related to
tardy ulnar nerve palsy.
posterior glenohumeral subluxation.
posterolateral rotatory subluxation of the elbow.
snapping medial triceps.
What is the etiology of cubitus varus following a supracondylar humerus fracture in a child?
Overgrowth of the lateral physis
Malreduction of the fracture
Growth arrest of medial physis
Injury to the ulnar nerve
Radial head dislocation
A 10-year-old boy sustained the injury shown in figure A while jumping off a trampoline. His hand is pulseless and cold. What is the next step in management?
Loose-fitting splint application and reassess in 1 hour
Emergent closed reduction and pin fixation
Open vascular exploration
Forearm skeletal traction pin
A 5-year-old boy sustains a type II (Gartland classification) supracondylar fracture which is treated with cast immobilization. Healing results in a mild gunstock deformity. Surgical treatment of this will most likely result in:
improved functional outcome
improved pain relief
improved range of motion
reduce non-union rates
The most common nerve injured in the fracture shown in Figure A innervates all of the following muscles EXCEPT?
flexor digitorum profundus index finger
flexor digitorum profundus middle finger
flexor pollicis longus
extensor pollicis longus
A 8-year-old boy has a cubitus varus deformity of his left elbow after a supracondylar humerus fracture was treated in a splint. What is the most common cause of this deformity?
Malreduction causing malunion
Medial epicondyle growth arrest
Lateral condyle overgrowth
Medial epicondyle avascular necrosis
Unrecognized compartment syndrome