Suggested Transfusion Guidelines for Red Blood Cells

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Case PresentationOrthopedic Surgery Lee Eunjoo

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Identifying DataName: Choi OO Age: 2 years and 9 months Sex: female

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Chief ComplaintLeft elbow pain

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Present IllnessAcute trauma history When : 2007. 6. 2. 7:40 PM Where : playground in restaurant How : fall on the outstretched hand with the elbow hyperextended

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Physical ExaminationExtremity • Left elbow LOM due to pain swelling/tenderness (+/+) external wound (-)

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Physical ExaminationExtremity • Left hand and fingers Moter/ Sensory /Circulation: intact

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X-ray: elbow AP., lat.

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Diagnosis Left humerus supracondylar fracture Gartland type Ⅱ

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Treatment CR & long arm cast immobilization

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Post casting X-ray

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Disease reviewSupracondylar fracture of humerus

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IncidenceUsually seen in the first decade of life. Most common(50-60%) fracture about the elbow in children Right : left = 39.2 : 60.8 Extension type: 96% Flexion type: less than 4%

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Mechanism of injuryExtension type - fall on the outstretched hand with the elbow hyperextended. Flexion type - fall on the olecranon with the elbow flexed.

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Classification (Gartland type)Classified according to the amount of displacement of the two fregments Type 1: undisplaced fracture Type 2: displaced fracture (intact posterior cortex) Type 3: displaced fracture (no cortical contact) - posteromedial (common) - posterolateral

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Physical ExaminationType1 and Type 2 - Swelling and Pain with attempted movement of the elbow - able to initiate a small amount of elbow motion because of the stability of the fracture.

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Physical ExaminationType 3 - Severe pain and swelling - unable to initiate any movement of elbow because of pain - Ecchymosis in the antecubital area - Puckering of the skin - Forearm : pronated

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Physical ExaminationComplete neurovascular evaluation - Doppler : vascular spasm, rupture, occlusion - Volkmann’s ischemia : pain, compartment tightness, decreasing motor & sensory function - Neurologic exam: median, ulnar, radial, anterior interosseous nerve

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ManagementType 1 - simple long arm cast immobilization for 3 weeks - 90° flexion, forearm neutral position

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ManagementType 2 - Stable after reduction : Cast immobilization - Unstable or vascular problem in hyperflexion : treat as type 3

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ManagementType 3 - Closed reduction - Assessment of quality of reduction - Stabilization with percuteneous pin (medial-lateral pinning)

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ComplicationsNeurologic injury (radial n. – m/c) Vascular compromise Cubitus varus, Cubitus valgus Myositis ossificans Nonunion AVN of trochlear

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Reference Green and Swiontkowski’s Skeletal Trauma in Children. 2nd edition. Rockwood and Wilkins’ Fractures in Children. 5th edition.

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Last Updated: 8th March 2018

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