2. Case report n°2 Medical Staff A&E 14/10/09 FVHospital Dr. David Tran

3. Case report Young girl 2 years ½ Coming to A&E because she fell down to the ground on her right elbow this morning Clinic exam: right elbow swelling, tender to touch

4. Xray of the right elbow

5. Details of the right elbow Xray

6. Management The orthopedist come to examine the girl: no evident fracture on Xray. An arm splint is put Prescription of Ibrafen & Efferalgan Advise to consult the orthopedist a few days later if not better An appointment with the orthopedist is given 5 days later

7. Follow up … The child didn t come to the orthopedist consultation (mistake of communication?) She didn t sent her daughter to A&E a few days later because the girl didn t complain … But 3 weeks later, the girl still refuse to move her elbow normally > the mother send her daughter to A&E in a Vietnamese hospital

8. Xray of the right elbow 3 weeks after the trauma

9. Xray comparison J 0 J 21

10. Xray comparison J 0J 21

11. Epicondyle fracture in children 10% of elbow fracture in child Frequency 6 to 8 years Mechanism: 1. Compression/extension 2. Compression/flextion 3. Traction/extension

12. Classification Classification de Lagrange et Rigault -grade I: non d é plac é (<2 mm), persistance d'une charni è re cartilagineuse ? stabilit é ?stabilit é ? -grade II: d é plac é (>2 mm), d é placement lat é ral du fragment condylien -grade III: d é placement majeur, translation et rotation du fragment condylien

13. Treatment of epicondyl fracture in children Stade 1: BABP (plaster) & orthopedic consultation 7 days after (ultrasound) Stade 2 & 3: surgical with lateral way pin http://www.saintluc.be/professionnels/services/orthopedie/traumatologie-pediatrique/pages/0.html

14. Conclusion Be care full of Xray in children & infants (lot of traps … ) Do not hesitate to review the patient J5/J8 Comparative Xray, Ultrasound or CT scanner can help us in difficult diagnosis

15. Basic rule in children s elbow Xray Radius axe Condyle nucleus Radius axe Condyle nucleus