Module 54, Pediatric Orthopaedist Level

A 12 year old right hand dominant female presented to the emergency room complaining of right forearm pain. The patient stated that while playing basketball she fell down and another player subsequently fell onto her right arm. Physical exam revealed an alert white female. The volar surface of the proximal forearm had two small puncture wounds. Radiographs revealed a comminuted fracture of the proximal one-third of the ulna with over-riding of the fragments. The radial head was dislocated anteriorly.

Question 54A

The most common complication of this fracture in children is poor reduction of the radial head.

Question 54B

The second most common complication is a malunion of the ulnar fracture.

Question 54C

The above child was treated with an open reduction of the ulna and a closed reduction of the radial head. At follow up of 6 weeks ossification was noted over the anterior lateral elbow. This heterotopic ossification is uncommon and seldomly severe enough to cause problems in this type of injury in children.

Question 54D

The most common nerve palsy to occur in this type of fracture with an anterior dislocation of the radial head is the radial nerve.

Question 54E

If the radial head can not be reduced or kept reduced after an anatomic reduction and fixation of the ulna, the problem is usually a severe disruption of the annular ligament which will need repair.