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Trash Lesions Around the Elbow: A Review of Approach to Diagnosis and Management

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Abstract

TRASH lesions are a group of special injuries around the elbow resulting from high energy trauma that are routinely missed at initial presentation because of seemingly normal X-rays. These are a group of osteochondral injuries having a high propensity for surgical intervention and usually have poor outcomes if not treated adequately. Prompt diagnosis warrants a high index of suspicion even when a radiograph appears to be normal with a disproportionately swollen elbow in a child. TRASH lesions include radial head osteochondral fractures, medial condylar fractures in unossified elbow, transphyseal separations of the distal humerus, monteggia lesions, entrapped incarcerated medial epicondylar fractures, capitellar shear fractures, lateral condylar fractures extending to the cartilage. This article attempts to review in brief, the approach to early diagnosis and management with literature review and case examples.

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References

  1. Brighton, B., & Vitale, M. (2015). Epidemiology of fractures in children. Rockwood and Wilkins’ Fractures in Children. pp. 1–7.

  2. Beaty, J. H., & Kasser, J. R. (2015). Evaluation of pediatric distal humeral fractures. Rockwood and Wilkins’ fractures in children. 8th ed. Philadelphia: Lippincott Williams & Wilkins. pp. 565–579.

  3. Waters, P. M., Beaty, J., & Kasser, J. E. (2010). TRASH” (The Radiographic Appearance Seemed Harmless) Lesions [Internet]. Journal of Pediatric Orthopaedics, 30, S77-81.

    Article  Google Scholar 

  4. Leung, A. G., & Peterson, H. A. (2000). Fractures of the proximal radial head and neck in children with emphasis on those that involve the articular cartilage. Journal of Pediatric Orthopedics, 20(1), 7–14.

    CAS  PubMed  Google Scholar 

  5. Van Zeeland, N. L., Bae, D. S., & Goldfarb, C. A. (2011). Intra-articular radial head fracture in the skeletally immature patient: Progressive radial head subluxation and rapid radiocapitellar degeneration. Journal of Pediatric Orthopedics, 31(2), 124–129.

    Article  Google Scholar 

  6. Ackerson, R., Nguyen, A., Carry, P. M., Pritchard, B., Hadley-Miller, N., & Scott, F. (2015). Intra-articular radial head fractures in the skeletally immature patient: Complications and management. Journal of Pediatric Orthopedics, 35(5), 443–448.

    Article  Google Scholar 

  7. Bell, S. N., Morrey, B. F., & Bianco, A. J., Jr. (1991). Chronic posterior subluxation and dislocation of the radial head. JBJS, 73(3), 392–396.

    Article  CAS  Google Scholar 

  8. Leet, A. I., Young, C., & Hoffer, M. M. (2002). Medial condyle fractures of the humerus in children. Journal of Pediatric Orthopaedics., 22(1), 2–7.

    PubMed  Google Scholar 

  9. Bensahel, H., Csukonyi, Z., Badelon, O., & Badaoui, S. (1986). Fractures of the medial condyle of the humerus in children. Journal of Pediatric Orthopaedics., 6(4), 430–433.

    Article  CAS  Google Scholar 

  10. Harrison, R. B., Brent Harrison, R., Keats, T. E., Frankel, C. J., Anderson, R. L., & Youngblood, P. (1984). Radiographic clues to fractures of the unossified medial humeral condyle in young children [Internet]. Skeletal Radiology, 11, 209–212.

    Article  CAS  Google Scholar 

  11. Fernandez, F. F., Vatlach, S., Wirth, T., & Eberhardt, O. (2019). Medial humeral condyle fracture in childhood: a rare but often overlooked injury [Internet]. European Journal of Trauma and Emergency Surgery, 45, 757–761.

    Article  CAS  Google Scholar 

  12. Abzug, J., Ho, C. A., Ritzman, T. F., & Brighton, B. (2016). Transphyseal distal humerus fracture. Instructional Course Lectures, 65, 379–384.

    PubMed  Google Scholar 

  13. Supakul, N., Hicks, R. A., Caltoum, C. B., & Karmazyn, B. (2015). Distal humeral epiphyseal separation in young children: an often-missed fracture-radiographic signs and ultrasound confirmatory diagnosis. AJR American Journal of Roentgenology, 204(2), W192–W198.

    Article  Google Scholar 

  14. Kamaci, S., Danisman, M., & Marangoz, S. (2014). Neonatal physeal separation of distal humerus during cesarean section. American Journal of Orthopedics (Belle Mead NJ)., 43(11), E279–E281.

    PubMed  Google Scholar 

  15. De Jager, L. T., & Hoffman, E. B. (1991). Fracture-separation of the distal humeral epiphysis. The Journal of Bone and Joint Surgery, 73(1), 143–146.

    Article  Google Scholar 

  16. Abe, M., Ishizu, T., Nagaoka, T., & Onomura, T. (1995). Epiphyseal separation of the distal end of the humeral epiphysis: A follow-up note. Journal of Pediatric Orthopaedics, 15(4), 426–434.

    Article  CAS  Google Scholar 

  17. Degreef, I., & De Smet, L. (2004). Missed radial head dislocations in children associated with ulnar deformation: Treatment by open reduction and ulnar osteotomy. Journal of Orthopaedic Trauma, 18(6), 375–378.

    Article  CAS  Google Scholar 

  18. Lincoln, T. L., & Mubarak, S. J. (1994). “Isolated” traumatic radial-head dislocation. Journal of Pediatric Orthopedics, 14(4), 454–457.

    Article  CAS  Google Scholar 

  19. Letts, M., Locht, R. A., & Wiens, J. O. (1985). Monteggia fracture-dislocations in children. The Journal of Bone and Joint Surgery, 67(5), 724–727.

    Article  CAS  Google Scholar 

  20. Gottschalk, H. P., Eisner, E., & Hosalkar, H. S. (2012). Medial epicondyle fractures in the pediatric population. JAAOS-Journal of the American Academy of Orthopaedic Surgeons., 20(4), 223–232.

    Article  Google Scholar 

  21. Stans, A. A., & Lawrence, J. T. (2015). Dislocations of the elbows, medial epicondylar humerus fractures. Rockwood and Wilkins’ fractures in children. 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams&Wilkins.

  22. Papavasiliou, V. A. (1982). Fracture-separation of the medial epicondylar epiphysis of the elbow joint. Clinical Orthopaedics and Related Research, 171, 172–174.

    Google Scholar 

  23. Marcu, D. M., Balts, J., McCarthy, J. J., Kozin, S. H., & Noonan, K. J. (2011). Iatrogenic radial nerve injury with cannulated fixation of medial epicondyle fractures in the pediatrichumerus: A report of 2 cases. Journal of Pediatric Orthopaedics, 31(2), e13–e16.

    Article  Google Scholar 

  24. Letts, M., Rumball, K., Bauermeister, S., McIntyre, W., & D’Astous, J. (1997). Fractures of the capitellum in adolescents. Journal of Pediatric Orthopaedics., 17(3), 315–320.

    CAS  PubMed  Google Scholar 

  25. Pradhan, B. B., Bhasin, D., & Krom, W. (2005). Capitellar fracture in a child [Internet]. The Journal of Bone & Joint Surgery, 87, 635–638.

    Google Scholar 

  26. Bryan, R. S. (1985). Fractures of the distal humerus. The Elbow and its Disorders. pp. 325–33.

  27. McKee, M. D., Jupiter, J. B., & Bamberger, H. B. (1996). Coronal shear fractures of the distal end of the humerus. JBJS, 78(1), 49–54.

    Article  CAS  Google Scholar 

  28. Agins, H. J., & Marcus, N. W. (1984). Articular cartilage sleeve fracture of the lateral humeral condyle capitellum: A previously undescribed entity. Journal of Pediatric Orthopedics, 4(5), 620–622.

    Article  CAS  Google Scholar 

  29. Drvaric, D. M., & Rooks, M. D. (1990). Anterior sleeve fracture of the capitellum. Journal of Orthopaedic Trauma, 4(2), 188–192.

    Article  CAS  Google Scholar 

  30. Suresh, S. S. (2009). Type 4 capitellum fractures: Diagnosis and treatment strategies. Indian Journal of Orthopaedics., 43(3), 286.

    Article  Google Scholar 

  31. Song, K. S., Kang, C. H., Min, B. W., Bae, K. C., & Cho, C. H. (2007). Internal oblique radiographs for diagnosis of nondisplaced or minimally displaced lateral condylar fractures of the humerus in children. Journal of Bone and Joint Surgery. American Volume, 89(1), 58–63.

    Article  Google Scholar 

  32. Song, K. S., & Waters, P. M. (2012). Lateral condylar humerus fractures: Which ones should we fix? Journal of Pediatric Orthopaedics., 1(32), S5-9.

    Article  Google Scholar 

  33. Foster, D. E., Sullivan, J. A., & Gross, R. H. (1985). Lateral humeral condylar fractures in children. Journal of Pediatric Orthopedics., 5(1), 16–22.

    Article  CAS  Google Scholar 

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  1. Department of Paediatric Orthopaedics, Sancheti Institute for Orthopaedics and Rehabilitation, 16 Shivajinagar, Pune, 411005, India

    Sandeep Patwardhan & Sujith Omkaram

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  1. Sandeep Patwardhan
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Patwardhan, S., Omkaram, S. Trash Lesions Around the Elbow: A Review of Approach to Diagnosis and Management. JOIO 55, 539–548 (2021). https://doi.org/10.1007/s43465-020-00333-x

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