Children - The Pulled Elbow.

Pulled Elbow – The wailing child with no fracture

With the school holiday on, I though this topic would be appropriate.

The pulled elbow occurs in children following a peculiar type of mechanism to the injury.

It usually involves a tug to the elbow of a child – which usually happens say when the caregiver – parent/nanny is trying to prevent the child from falling or preventing the child from crossing the street.

The child classically holds the elbow straight or slightly bent and particularly resists movement at the affected elbow. This often mimics a fracture at the elbow.

What happens?

The elbow joint consists of 3 bones – the arm bone, the humerus; the two forearm bone, the radius and ulna. The forearm bones are linked at the elbow by the annular ligament and it is the slipping of the head of the radius from this ligament which brings about the condition.

Treatment

A good history – if classical and clinical evaluation is all that is required for a diagnosis. Often an x-ray is not necessary. I request for an x-ray to rule out a fracture around the elbow if the examination of the child me doubt the diagnosis of a pure pulled elbow – this usually is the case if the elbow is unduly swollen.

Manipulation is done in the clinic-emergency room. If done correctly - with reduction of the radial head, the child is comfortable within minutes and often starts using the limb. It is therefore important to review the child after 15-20 minutes. An arm sling is often used but often unnecessary with the child often discarding it within hours.

Note – Pictures from Netter’s Atlas of Orthopaedics

Children and Sports

Children and Sports - The Bigger Picture - BFM 89.9 - 25/10/2011

... Whether you're dreaming of moulding your child into the next sport superstar or just want to keep them healthy and fit, find out about the do's and don'ts of sport participation and fitness training for children, from Dr. Harjeet Singh, a Consultant Orthopaedic Surgeon.
Dr Harjeet will also advise on ways to optimise the benefits of sport for children, while reducing the risks...

Flat Feet in Children - The Basics

 FLAT FEET.

I have recently had a number of relatives and patients coming over with their children for an opinion on flat feet and it is interesting that most of them have gleaned a lot of information off the net, from friends and possibly from their friendly neibourhood aunty-patti-makcik too.

The start off this session,  it is necessary to understand how the foot develops in order to have an idea (and possibly worry a teeny weeny bit less)  about flat feet.

At birth, the newborn usually has the foot turned outwards (eversion) and upwards (dorsiflexion). This is due to the natural position in utero. As the child starts standing – usually around the age of one year, the foot nearly always looks flat, particularly because there is a large pad of fat on the inner side of the foot. This is a normal.

As the child grows further, walking makes the child’s foot look particularly flat. This is especially so, as the initially way of walking involves the foot being turned outwards.. The arch of the foot starts developing at the age of 3 onwards. If it doesn’t, and the feet remain flat, it is important to get a consult to check for flexibility of the child in general and the foot in particular. Usually the child is more flexible and these feet are then called flexible flat feet which in principle require no treatment.

Simple tests for flat feet include 1. Great Toe Extension Test - moving the great  toe upwards and seeing if the arch at the inner part of the foot forms. If so,  don’t worry! This means that in function, the arch does develop and biomechanically the foot is sound. 2. The Toe Off - In older children, you could ask them to tip toe while viewing from the back. Forming of an curve in the inner part of the foot with the heel turning inwards denotes good function. 3. If these tests seems complicated (or the way I explain then causes headaches, consider the simple wet tissue test  - this helps determine whether the foot is flat in the first place). Get the child to step on a blotting paper or tissue after stepping into water first. The pattern formed indicates whether the foot is flat (overpronating).

When do you worry? Please consider an early consult if the child complains of pain over the inner and outer part of his feet – flexible flat feet are usually pain free. This is especially so if the foot seems rigid and less flexible. As always, when in doubt, please visit your friendly Orthopod!!

Children and Sports