Description
This video presentation features Dr. Dan Perry, a pediatric orthopedic surgeon from Alder Hey Children's Hospital, discussing the management of children's elbow fractures, particularly supracondylar fractures, which are common in pediatric trauma. Dr. Perry outlines crucial questions regarding these fractures, such as whether they should be surgically fixed and how to handle complications like nerve injuries and 'pink pulseless hand.'
He explains the importance of assessing the fracture's alignment through X-rays, especially using the anterior humeral line and Baumann's angle, and emphasizes the significance of comparing with the normal arm to identify abnormalities. Dr. Perry describes the treatment protocol for undisplaced fractures, recommending a back slab for pain control over a collar and cuff based on a past study from Alder Hey.
As he dives into more complex Type 2 and 3 fractures, he discusses treatment approaches, including the use of crossed or lateral wires during fixation, and stresses the need for proper neurovascular documentation pre-and post-surgery. Dr. Perry reassures that most nerve injuries recover, highlighting the importance of careful monitoring and patient reassurance.
Addressing concerns regarding the pulseless hand, he advises an urgent closed reduction if the hand is cold, but recommends observation for a pink hand that is perfectly reduced.
The discussion also covers the management of lateral condyle fractures and medial epicondyle fractures, noting that the evidence for surgical intervention is not clear-cut, hence suggesting the need for a rational talks with families about their options. He concludes with a summary of the key points and the importance of participating in ongoing studies to address these common injuries effectively.