(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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The injury pattern seen in Figure A following minimal trauma is consider to be highly suspicious of which of the following conditions?
Aneurysmal bone cyst
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Figure A shows a displaced olecranon fracture in a skeletally immature patient. Olecranon fractures are highly suspicious for osteogenesis imperfecta.
Osteogenesis imperfecta (OI) is a hereditary condition that results in a decreased production or secretion of Type I collagen. Bone fragility and fractures are a common manifestation of this condition. An olecranon fracture in a normal child is typically very rare. Therefore, displaced fractures of the olecranon after trivial trauma may be highly suspicious for OI.
Zoints et al. reviewed 17 fractures of the olecranon apophysis in 10 children with mild osteogenesis imperfecta. They suggest that olecranon fractures may be pathognomonic of mild OI in otherwise healthy-appearing children. The high rate of bilateral injury (70%) suggests that children with OI who sustain this fracture should be counseled regarding the risk of injury to the opposite extremity.
Stott et al. reviewed 7 fractures of the apophysis of the olecranon in five children who had mild osteogenesis imperfecta. They found that cast immobilization with careful follow-up may be used for minimally displaced fractures, but operative treatment is recommended for displaced fractures.
Illustration A shows fixation of the olecranon fracture using tension band wiring.
Answers 2,3,4,5: Olecranon fractures in skeletally immature patients are pathognomonic of osteogenesis imperfecta.
Stott NS, Zionts LE.
J Bone Joint Surg Am. 1993 Jul;75(7):1026-33. PMID: 8335662 (Link to Abstract)
Stott, JBJS 1993
Zionts LE, Moon CN
J Pediatr Orthop. 2002 Nov-Dec;22(6):745-50 PMID: 12409900 (Link to Abstract)
Zionts, JPO 2002
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HPI - 8 years boy with history of full down over Rt elbow since 3 days presented with complain of pain & swelling and limitation of movement over Rt elbow
What is the optimal treatment for this pediatric olecranon fracture?