(1) +/- one year, varies between boys and girl. C-R-I-T-O-E to remember age of ossification. CTE-R-O-I to remember age of fusion (capitellum, trochlea and external (lateral) epicondyle fuse together at puberty. Together they fuse to the distal humerus between the ages of 14-16 years old)
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Which of the following fracture patterns (Figures A-E) is most commonly associated with a combined ulnohumeral and radiocapitellar elbow dislocation in children?
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An 11-year-old boy presents to the emergency room with a left elbow injury after falling off of the monkey bars. His neurovascular examination in the extremity is normal and his pain is controlled. Post-reduction radiographs are shown in Figure A. What is the next most appropriate step in management
Hinged elbow brace locked at 90 degrees of flexion for 10 days followed by gentle passive range of motion
Open reduction and internal fixation
Long arm cast for 4 weeks
Sling for comfort and return to activities as tolerated
A 9-year-old boy fell off of a swing set and injured his left elbow. Radiographs are shown in Figures A and B. Open reduction and internal fixation of this fracture is indicated secondary to which of the following:
Displacement of greater than 5 mm
An incarcerated fragment in the ulnohumeral joint
2+ valgus laxity seen with manual stressing
To prevent cubitus valgus deformity
High risk of symptomatic non-union of fragment
Which of the following muscles is involved in the avulsion injury that creates the fracture shown in Figure A?
Extensor carpi radialis longus
An 11-year-old child sustains an elbow dislocation. The elbow is reduced, but post-reduction radiographs demostrate that the ulnohumeral joint remains slightly incongruent. What is the most likely etiology for this continued incongruency?
Interposed annular ligament
Interposed lateral epicondyle fragment
Interposed medial epicondyle fragment
Interposed ulnar nerve
Interposed brachialis muscle
A 15-year-old Little League pitcher sustains an injury to his dominant elbow shown in Figure A. Radiographs demonstrate 7 mm of displacement. Which of the following treatments will result in the highest rate of bony union?
Long arm cast for 1 week, followed by passive and gentle active ROM
Placement in a hinged elbow brace with immediate active motion
Closed reduction followed by K-wire fixation
Fragment excision and flexor/pronator mass re-attachment