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Percutaneous pinning
8%
171/2232
Hinged elbow brace locked at 90 degrees of flexion for 10 days followed by gentle passive range of motion
169/2232
Open reduction and internal fixation
58%
1300/2232
Long arm cast for 4 weeks
22%
485/2232
Sling for comfort and return to activities as tolerated
4%
91/2232
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Figure A shows a displaced medial epicondyle fracture that is incarcerated in the ulnohumeral joint following an attempt at closed reduction. Closed reduction manuever to extricate the incarcerated fragment can be performed with the Roberts' technique, which includes placing valgus stress on the elbow, supinating the forearm, and extending the wrist and fingers. Medial epicondyle fractures with incarcerated fragments that fail manipulative closed reduction require open reduction. In contrast, displaced medial epicondyle fractures can be treated with closed management if the fragment is not incarcerated in the joint. Farsetti et al. compared the long-term results of pediatric patients with non-incarcerated medial epicondyle fractures with displacement >5 mm who received a long arm cast without reduction, ORIF, and excision. There was no difference in clinical results between patients treated with ORIF and those who received non-operative treatment, while those treated with excision had poor long term results. In practice, the magnitude of acceptable displacement of these fractures is highly variable among surgeons. Illustration A demonstrates the incarcerated medial epicondyle with red arrows.
4.1
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