Multiple Unilateral Upper Limb Fractures in the Pediatric Setting - A Case Report

Lateral condyle fractures and both bone forearm fractures account for 10-15% and 13-40% of all elbow fractures in children, respectively. About 5% of forearm fractures in children have associated supracondylar fractures; hence, any forearm fractures warrant a careful examination of the elbow, and any radiographs taken should visualize the elbow joint above and wrist joint below for other injuries. We report a case of multiple upper limb fracture in a child, comprising lateral condyle and both bone forearm fractures.

A 5-year-old boy was admitted through the emergency department at our district general hospital having fallen from a ladder approximately 1.5 m high in a playground. The limb was significantly deformed, with no evidence of an open injury, and remained neurovascularly intact throughout. Radiographs demonstrated a minimally displaced lateral condyle fracture of the left elbow, a midshaft ulna fracture, and a displaced off-ended distal third radius and ulna fracture of the left wrist. Any metabolic bone disease and non-accidental injury was ruled out. The patient was initially managed in an above elbow plaster cast, with elevation and monitoring for any neurovascular compromise. Computed tomography imaging was performed to completely assess the fracture pattern and for discussion with our local regional trauma center. Given the minimal displacement of the lateral condyle fracture, a conservative course of management was decided for this. The displaced distal radial fracture was managed with open reduction and internal fixation with a plate and the ulna shaft fracture with manipulation and plaster cast application. By 12 weeks after surgery, there was a full range of movement of the elbow, wrist, and forearm with complete radiological union.

This case emphasizes the importance of a secondary survey in the context of even minor trauma to rule out concurrent injuries. We found that minimally displaced lateral condyle fractures can be managed conservatively, and single-bone fixation in both bone forearm fractures can lead to very satisfactory outcome, with preference for plate and screw fixation for unstable fractures within the metaphyseal/diaphyseal junction.