distal phalanx transphyseal fracture

It is also referred to as the terminal phalanx. For example, the medial epicondyle usually ossifies prior to the trochlea. In infants, the distal humeral physis has a flat transverse configuration without the stability afforded by a V-shaped configuration in older children. Overview of the contemporary management of supracondylar humeral fractures in children. Functional outcome of the elbow in toddlers with transphyseal fracture of the distal humerus treated surgically. (2013) Hand clinics. Finnbogason T, Karlsson G, Lindberg L, Mortensson W. Nondisplaced and minimally displaced fractures of the lateral humeral condyle in children: a prospective radiographic investigation of fracture stability. Wolters Kluwer Health Finger fractures and dislocations are common injuries that are often managed by family physicians. Transphyseal fracture. The thumb connects to the hand through the Goto A, Murase T, Moritomo H, Oka K, Sugamoto K, Yoshikawa H. Three-dimensional invivo kinematics during elbow flexion in patients with lateral humeral condyle nonunion by an image-matching technique. The pin was removed at her 6-week follow-up, at which time there was some early consolidation of the fracture on imaging. Loss of thumb function due to a fracture can affect your ability to grasp items, and certain types of thumb fractures can increase the risk of arthritis later in life. T1-weighted MRi showx lack of osseous union. To achieve stability, a 20-G needle was introduced through the tip of the distal phalanx under fluoroscopic guidance. Cubitus varus. However, such an injury may be suggested by localized tenderness and soft tissue swelling and by the presence of a posterolateral elbow dislocation. Distal phalanx fractures represent common sports and work-related injuries, accounting for approximately half of all hand fractures [ 1-3 ]. On the anteroposterior view (C), the fracture may clearly be seen to extend all of the way across the metaphysis. Between these grooves is the lateral crista of the trochlea, which provides lateral stability to the trochleoulnar joint. (2017) RadioGraphics. J Hand Surg Eur Vol. Fat pad signs indicate an elbow joint effusion. Overall, many thumb fractures have good outcomes after appropriate treatment. The American College of Radiology Appropriateness Criteria for chronic elbow pain includes the following The location of the medial humeral epicondyle in children: position based on common radiographic landmarks. Surgery for nailbed repair and/or Kirschner wire fixation will be required in more complex cases. Philadelphia, PA: Lippincott Williams & Wilkins; 2015:427438. Prompt and accurate diagnosis of the injury is crucial for a successful outcome. 2016 Apr. Transphyseal fracture. As in all cases of trauma, the importance of recognition of open distal phalanx fractures is due to the increased risk of contamination and, hence, infection. They are intra-articular injuries in which the fracture extends through the epiphysis, across the physis and through the metaphysis. Olecranon avulsion fracture. Lateral condyle fractures may be associated with other elbow fractures. Assessment of stability is necessary for appropriate management of dislocated joints. ("Articular" means "joint.") Percutaneous pinning of distal phalanx fractures in the ED using an 18- or 20-G hypodermic needle is an effective treatment with minimal early complications. In the absence of associated microvascular injury, most fractures can be stabilized nonurgently and subsequently scheduled for surgery on an outpatient basis. Like the other long bones in the hands, each distal phalanx is separated into a head, body or shaft, and a base [3]. Illustration showing the bones and joints of the thumb. (B) The ulnar fracture has apex lateral angulation and is well aligned on the lateral view. J Bone Joint Surg Am. Transphyseal fractures of the distal humerus typically occur in children younger than 3 years secondary to birth trauma, nonaccidental trauma, or a fall from a small In addition, usually, the trochlea initially appears as multiple fragmented ossification centers; by contrast, the medial epicondyle has a smooth and regular appearance. Radiographic findings in supracondylar fracture. It is imperative that extension is maintained at all times during treatment because any flexion can affect healing and may extend the treatment period. The distal ulnar epiphysis is best depicted on the anteroposterior view, on which it is seen to overlap the ulnar metaphysis. [17]. 2017 Feb 20. Finger fractures involving greater than 30 percent of the intra-articular surface should be referred to an orthopedic or hand surgeon. WebFractures of the distal phalanx are typically treated nonoperatively. When the medial epicondyle is pulled downward (distally) by the forearm flexor muscles, it may enter the medial joint space. [32] If this does not adequately restore circulation, vascular repair, usually following arteriography, may be needed. The medial epicondyle usually develops as a single center. A study by Garon et al1 found significant cost reductions in nonphysician labor and materials for proximal phalanx fractures treated in procedure rooms rather than the ER. However, unlike supracondylar fractures, lateral condyle fractures are seldom associated with fractures remote from the elbow. Anteroposterior (A) and lateral (B) views. Wilkins KE. On the lateral view, cortical disruption is usually seen posteriorly rather than anteriorly as in supracondylar fractures. Fractures of the medial epicondyle account for 10-15% of elbow fractures in children. Supracondylar fractures usually extend transversely across the metaphysis, whereas lateral condyle fractures are oblique and more distal. The lateral epicondyle usually fuses to the distal humeral epiphysis (lateral condyle) before fusing to the metaphysis. Oblique views may be required to depict these fractures, since some are not apparent on AP views. 41 (7):1453-1461. [QxMD MEDLINE Link]. Felix S Chew, MD, MBA, MEd is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, International Skeletal Society, Radiological Society of North AmericaDisclosure: Nothing to disclose. For reprint requests, or additional information and guidance on the techniques described in the article, please contact Rebecca G. Burr, MD, at [emailprotected] or by mail at Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center Maywood, IL 60153. J Pediatr Orthop. Disclaimer. Anteroposterior (A) and lateral (B) views of the injured left elbow with anteroposterior (C) and lateral (D) views of the right elbow for comparison. (B) Lateral view. Common complications of these injuries are: altered sensitivity (numbness, hyperesthesia, tenderness) cold sensitivity (cold intolerance) restriction of DIP joint movement 2012 Jul-Aug. 32(5):477-82. These fractures are commonly classified as intra- or extra-articular. New York: Churchill Livingstone. Supracondylar fracture. [Full Text]. The mechanism of injury may be rotational shear. Richard M Shore, MD Professor, Department of Radiology, Northwestern University, The Feinberg School of Medicine; Head, Division of General Radiology and Nuclear Medicine, Ann and Robert H Lurie Children's Hospital of Chicago See the image below. Cost and complications of percutaneous fixation of hand fractures in a procedure room versus the operating room. Tuft fracture (Figure 3) is the most common type of distal phalanx fracture. Rotator Cuff and Shoulder Conditioning Program. The capitellum and radiocapitellar joint are best seen on the radiocapitellar view. [QxMD MEDLINE Link]. The smooth end of the ulna is the metaphysis ending at the physial fracture. Injury and follow-up x-rays for a 19-month-old middle finger distal interphalangeal joint fracture dislocation treated with closed reduction and, Injury, postreduction, and follow-up x-rays for a small finger. In children younger than 5 years, the annular ligament is relatively loose, allowing the radial head to be pulled through it when acute traction is suddenly placed on a pronated forearm (which is the usual position of the forearm when a child is being pulled along by an adult). Sometimes, thumb fractures can result in joint instability when they involve the important ligaments that keep the joints aligned. Lateral view shows the 2 lines used for radiographic analysis in patients with elbow trauma. This content is owned by the AAFP. [QxMD MEDLINE Link]. Typically, the most concerning and problematic broken bones involve the joints. J Bone Joint Surg Br. Crush injuries often have associated soft-tissue Radiographic findings in lateral condyle fracture. 2018 Jul. Fractures and dislocations of the elbow region. J Pediatr Orthop. Most proximal radial fractures in children are either Salter-Harris type II injuries that extend through the growth plate and the lateral aspect of the metaphysis or metaphyseal fractures that extend across the neck near the growth plate but do not involve the growth plate directly. Entrapment is particularly common after an elbow dislocation or subluxation. [QxMD MEDLINE Link]. At the time the article was last revised Craig Hacking had no recorded disclosures. In a transphyseal fracture, the epiphysis is usually medially displaced relative to the metaphysis (see the image below). In particular situations, such as with young children, conscious sedation can be provided by ED physicians to make the procedure more tolerable. Reference article, Radiopaedia.org (Accessed on 01 May 2023) https://doi.org/10.53347/rID-41775, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":41775,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/distal-phalanx-fracture/questions/1272?lang=us"}. Indirect insults lead to different sequelae that are based on whether the epiphyseal blood supply or metaphyseal On clinical examination, the fingertip is A volar dislocation (Figure 2) can be accompanied by avulsion of the central slip extensor mechanism of the PIP. The fractured medial epicondyle may become entrapped in the elbow joint, representing a major complication. Our proposed technique would not deviate from that standard protocol. Okumura Y, Maldonado N, Lennon K, McCarty B, Underwood P, Nelson M. Point-of-Care Ultrasound: Sonographic Posterior Fat Pad Sign: ACase Report and Brief Literature Review. Rabiner JE, Khine H, Avner JR, Friedman LM, Tsung JW. [QxMD MEDLINE Link]. Salter-Harris fracturesare a group childhood injuries where a fracture involves the physis. These fractures are Proximal radial fractures in children are frequently associated with other injuries; such injuries most frequently involve the olecranon. Despite its frequency, there is no clear consensus on the proper treatment of mallet fractures. Hence, lateral condyle fractures are Salter-Harris type IV injuries, even though they often have the radiographic appearance of a Salter-Harris type II injury. The needle should be advanced across the DIP into the middle phalanx and this position should be confirmed with the mini c-arm. 2019 Feb 1;13(1):47-56. doi: 10.1302/1863-2548.13.180156. On the lateral view, a thin metaphyseal flake is present posteriorly and indicates a Salter-Harris type II injury rather than the usual Salter-Harris type I injury. Bright RW, Burstein AH, Elmore SM. 2008;1:97102. [QxMD MEDLINE Link]. The peak age is 5-7 years, and the nondominant arm is involved more frequently than the dominant arm. The technique is cost and time effective when treating patients with this type of injury. Dislocations of the DIP joint are often associated with trauma and may have associated fractures and soft tissue injury.7 A simple dorsal DIP dislocation should be evaluated with radiography to assess for fracture. Some common finger fractures can be treated conservatively with appropriate reduction and immobilization. 2010 Dec 1. Plastic bowing, torus and greenstick supracondylar fractures of the humerus: radiographic clues to obscure fractures of the elbow in children. Although it is important to differentiate medial condyle fractures from medial epicondyle fractures, the distinction is not always easy to make with radiographs. WebDistal Phalanx Fractures Tuft Fracture (crush injury) Soft tissue injury is often more obvious; Xray required to detect underlying fracture Management consists mainly of As with lateral condyle fractures, these are typically Salter-Harris type IV injuries. 64B:256. If extensive loss of motion persists, referral is recommended. Ann Emerg Med. WebYou have broken your distal phalanx (the end of your finger). Salter-Harris type IV injuries will often follow typical location patterns and most commonly involve the distal radius, phalanges and distal tibia. The lucent cleft in the fracture fragment is the normal olecranon growth plate. Olecranon fractures may be associated with lateral condyle fractures with varus stress or medial epicondyle fractures with valgus stress. Both direct and indirect findings are helpful in the radiographic diagnosis of supracondylar fractures. Radiology of Skeletal Trauma. Duffy S, Flannery O, Gelfer Y, Monsell F. Eur J Orthop Surg Traumatol. Barton KL, Kaminsky CK, Green DW, et al. In the remainder of patients, fractures/dislocations are divided equally between posterior (Monteggia type 2 injury) and lateral (Monteggia type 3 injury) dislocation of the radial head. 295(6590):109-10. J Bone Joint Surg Am. The characteristic location of the olecranon ossification centers, their smooth uninterrupted cortical margins, and the typical appearance of the partially fused physis help in distinguishing olecranon ossification from fractures at that site. At surgical exploration, the brachial artery was transected at the level of the fracture. 39(2):163-71, v. [QxMD MEDLINE Link]. Pediatric supracondylar fractures and pediatric physeal elbow fractures. A physical examination is crucial in the assessment of finger injuries. Displaced proximal radial fracture. Clinical features that suggest a medial condyle fracture include instability and a limitation of elbow motion. Ultrasound evaluation of the ulnar collateral ligament of the elbow: Which method is most reproducible?. Your surgeon will discuss with you which option is best for your fracture. However, the trochlea does not become ossified before the medial epicondyle. The fracture then propagates through the physis and eventually passes into the metaphysis, producing a typical Salter-Harris appearance. Referral to a hand specialist is required if a fracture is unstable, involves a large portion (greater than 30 percent) of the intra-articular surface, or has significant rotation. A more recent article on common finger fractures and dislocations is available. Angular deformity also results from rotation at an oblique fracture line. 2018 Sep. 33 (5):444-446. Rang M. Children's Fractures. Lateral and volar PIP dislocations are less common than dorsal injuries. Monteggia variant. This website also contains material copyrighted by 3rd parties. Fractures with significant radiological comminution and/or extensive soft tissue injury should be clinically and radiologically reviewed for open fracture. Abzug JM, Herman MJ. Unable to process the form. The authors recommend that the pin remain in place for 4 weeks in pediatric patients and for 4 to 6 weeks in adults, using clinical and radiographic healing as a guide for removal. JAMES R. BORCHERS, MD, MPH, AND THOMAS M. BEST, MD, PhD. 128(1):145-50. Monteggia fracture/dislocation involves dislocation of the radial head accompanied by fracture of the proximal or mid ulna, with the apex of the ulnar fracture pointing in the same direction as the radial head dislocation. Depending on the particular injury pattern, a closed reduction is performed of the distal phalanx fracture and/or distal interphalangeal (DIP) joint dislocation. At the time the article was created Tom O'Graphy had no recorded disclosures. Pain and swelling: Take your normal painkillers if you are in pain. Anteroposterior (A) and lateral (B) views. Saper MG, Pierpoint LA, Liu W, Comstock RD, Polousky JD, Andrews JR. Sep 2006. Finger fractures and dislocations may occur during daily activities, such as work, but usually occur during participation in sporting activities. 2015 Feb. 27 (1):58-66. Philadelphia, PA: Wolters Kluwer/Lippincott, Williams & Wilkins; 2010. Although the annular ligament becomes transiently interposed between the radial head and capitellum, this movement does not cause recognizable widening of the radiocapitellar joint. Your surgeon may use one of several operative fixation techniques to realign the bone fragments. The articular relations of the medial condyle and proximal ulna are not as easy to evaluate in the immature skeleton. Radiographically occult bone abnormalities can be detected with MRI, CT, or bone scintigraphy. The rest of the radius appears dislocated with respect to the capitellum; however, this is a displaced fracture rather than a dislocation (see the image below). 2. Supracondylar fractures may be complete or incomplete and have a wide range of severity. Although not routinely acquired, this view may be useful when a fracture is highly suspected but is not found on standard views. How displaced are "nondisplaced" fractures of the medial humeral epicondyle in children? Rarely, a Salter-Harris type IV fracture extends vertically through the metaphysis and epiphysis, crossing the physis. If these fractures are stable, they can be treated nonoperatively with splintage. Postreduction radiography can be used to assess alignment. Radiology. [5] On lateral views, cortical disruption is usually seen posteriorly rather than anteriorly, as with supracondylar fractures (see the image below). Phalanx fractures in adults are often slow to demonstrate callous, so clinical improvement is often a more reliable guide for early healing than the presence of callous on x-rays. 1990. [Simple elbow dislocations in children : Systematic review and meta-analysis]. Vertically oriented fracture begins along the medial aspect of the distal humeral metaphysis and extends to the growth plate. For surgeons with CRPP experience, there is a low learning curve for this bedside procedure. Apparent anterior dislocation of the proximal radius, as seen on the lateral view, is actually a proximal radial fracture with anterior displacement of the neck and shaft relative to the poorly visualized radial head that still articulates normally with the capitellum. This humeroulnar or trochleoulnar joint is a hinged articulation that essentially permits motion in a single plane, allowing flexion and extension. Flynn JC, Richards JF Jr, Saltzman RI. Richard M Shore, MD is a member of the following medical societies: American Roentgen Ray Society, American Society for Bone and Mineral Research, International Skeletal Society, Society for Pediatric Radiology, Society of Nuclear Medicine and Molecular ImagingDisclosure: Nothing to disclose. In evaluating the proximal ulna in children, the normal olecranon apophysis must not be mistaken for a fracture fragment. [QxMD MEDLINE Link]. Understanding the developmental anatomy of the pediatric elbow helps ensure that normal ossification centers are not misinterpreted as fracture fragments. If the elbow is mature enough for ossification of the medial epicondyle to be expected, the position of the medial epicondyle should be verified. This relation should be examined on a frontal view as well. [QxMD MEDLINE Link]. However, because the lateral epicondyle is the last center in the elbow to ossify, most pediatric patients with lateral condyle fractures have elbows that are too immature to have a lateral epicondyle ossification center. Initial anteroposterior (A) and lateral (B) views show a nondisplaced lateral condyle fracture. The stability of the distal fragment is partly determined by whether the fracture extends all the way to the articular surface or whether a cartilaginous hinge remains intact to help prevent motion of the fracture fragment. Typically, none of these centers is ossified at birth. Referral to a hand specialist is needed if a dislocation cannot be reduced; is unstable following reduction; or involves significant ligament, tendon, or soft tissue injury. Distal phalanx fractures represent common sports and work-related injuries, accounting for approximately half of all hand fractures [ 1-3 ]. MRI, US, or arthrography may be used to directly depict the relationship of the cartilaginous distal humeral epiphysis to the metaphysis (see the image below). 2016. sharing sensitive information, make sure youre on a federal Elbow fractures are the most common type of fractures in children, primarily occurring from a fall on an outstretched hand. In fact, Monteggia variant and pseudo-Galeazzi injuries are forearm fractures involving both bones, with 1 of the fractures occurring so close to the joint that a dislocation is erroneously suggested. Note associated proximal radial metaphyseal fracture. Oman Med J. Metacarpal fractures are seen more often in adults, whereas phalangeal fractures are more common in children [ 2 ]. Medial epicondyle fractures are 3 times more common in boys than girls and tend to occur in older children more often than supracondylar or lateral condyle fractures, with a peak age of 11-12 years, although younger children may also be affected. J Child Orthop. Digital blocks are readily performed in the ER and typically provide adequate anesthesia for this procedure. Transphyseal fracture. However, in approximately 25% of cases, the fracture may be subtle. Wheeler DK, Lindscheid RL. Elbow fractures include supracondylar, lateral condyle, medial condyle, radial head and neck, and olecranon. Rha E, Lee M, Lee J, et al. 3. 2016;41:990994. The radial head epiphysis may show displacement with varying amounts of shift and angulation that may lead to limitation of motion of the proximal radioulnar joint. On the initial anteroposterior view (B), the fracture is subtle and is seen only medially. J Shoulder Elbow Surg. In young patients, alignment of the radiocapitellar joint is evaluated by using the radiocapitellar line, whereas in the more mature skeleton, articulating surfaces of the radial head and capitellum are revealed directly. [24], Complications of medial epicondyle fracture. Treatment of a mallet fracture includes splinting the distal interphalangeal joint in extension; various splint types are of equal benefit. Passage of the anterior humeral line either anterior to the capitellum or through the anterior third of the capitellum demonstrates that the capitellum is positioned too far posteriorly; this finding indicates a distal humeral fracture. Appropriate referral to a hand surgeon may prevent delay in necessary treatment. [34] Although this has not been shown in several other series, including prospective studies, in most cases supracondylar fractures are now treated with only lateral pins to avoid nerve injury. A role for 3-D kinematic analysis of CT and MRI imaging for evaluation of lateral condyle fracture with nonunion has also been proposed About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an FAAOS Surgeon. If separation is significant, as shown below, recognition of the fracture is easy, although distinguishing these fractures from supracondylar fractures depends on knowing the characteristic course (see the image below). The goals of this simple intervention are to decrease unnecessary burden on the health care system, provide better care to patients, and potentially improve outcomes for patients with this type of injury. Bone fixation techniques include devices that hold the bone fragments in place either inside the body (internal fixation) or outside the body (external fixation). In those cases in which vascular injury is recognized, reduction usually corrects the vascular abnormality, and hence reduction and pinning should not be delayed for arteriographic assessment. Management of vascular injuries in displaced supracondylar humerus fractures without arteriography. Jpn J Radiol. Techniques in Orthopaedics36(4):514-516, December 2021. The ulna articulates with the humerus at the trochlea, which is the grooved and rounded medial articular portion of the distal humerus. modify the keyword list to augment your search. Metatarsal shaft fractures most commonly occur as a result of twisting injuries of the foot with a static forefoot, or by excessive axial loading, falls from height, or direct trauma. This finding is indicative of a nondisplaced fracture. [QxMD MEDLINE Link]. Closed treatment has been recommended for tendon avulsions. With subtle fractures, the fracture line may be initially seen through only a portion of the metaphysis. Salter-Harris type I fractures that pass entirely through the physis of the olecranon apophysis may occur, but they are relatively uncommon. Particularly common are those involving the olecranon (shown below), which occur with varus stress applied to a fully extended elbow with the olecranon locked in the olecranon fossa. Milch H. Fractures and fracture dislocations of humeral condyles. When the proximal radius and ulna return to normal position, the capitellum may shear off the radial head, leaving it posteriorly displaced. Transphyseal fractures of the distal humerus typically occur in children younger than 3 years secondary to birth 2012 Feb. 20(2):69-77. Radiography should be performed before further reduction attempts. Subsequent views (C and D) show lateral and posterior displacement of a distal fragment. [41] : Stage I fractures have an intact articular surface. [Guideline] Hayes CW, Roberts CC, et al. Transphyseal fracture (also called transcondylar fracture) is a fracture through the distal humeral physis that separates the entire distal humeral epiphysis from the metaphysis. 1) and a protective splint was placed. Careers. Fracture rotation can be difficult to assess radiologically and is best assessed on clinical examination. With acute valgus stress, the medial side of the elbow joint is opened. A Monteggia variant has fractures of the radius and ulna. The distal phalanx and proximal phalanx connect via the interphalangeal (IP) joint, which allows you to bend the tip of your thumb. A fluoroscopic image of the selected needle next to the distal phalanx before insertion can help to confirm the appropriate needle choice. 1. Because the entrapped medial epicondyle is positioned just distal to the medial side of the distal humeral metaphysis, it may be misinterpreted as the ossification center for the trochlea. Anterior displacement of most of the distal ulna relative to the wrist is due to a distal ulnar growth plate fracture, with anterior displacement of the metaphysis relative to the epiphysis, which still articulates normally with the wrist. In: Rockweed CA, Wilkins KE, King RE, eds. 65 (10): 773-80. The PIP joint is the most commonly dislocated finger joint.5 Injuries to the MCP joint often occur in the thumbs.6 Dislocations of DIP joints are commonly traumatic and often complicated by fracture and soft tissue injury.7. Although the Baumann angle usually is defined as the angle between the growth plate for the capitellum and a line drawn perpendicular to the humeral shaft, the need to draw the perpendicular line can be avoided by using the complement of the angle between the capitellar growth plate and the humeral shaft. 32(4):373-7. Clipboard, Search History, and several other advanced features are temporarily unavailable. Most cases of isolated radial head dislocation in children are likely to actually be Monteggia fracture/dislocation with a subtle ulnar bowing fracture. The mean annual incidence was 0.8 per 105. 30(3):253-63. All material on this website is protected by copyright. 2007;27:154157. Reduction of a dorsal PIP dislocation should be attempted at the time of injury, if possible, by applying traction and volar pressure on the middle phalanx at the PIP joint (Figure 1). WebTransphyseal fractures of the distal humerus typically occur in children younger than 3 years secondary to birth trauma, nonaccidental trauma, or a fall from a small height. Rarely, the medial epicondyle may also be fractured by direct trauma. Characteristics All of the bones in the thumb are susceptible to fracture. Pulled/nursemaid's elbow. 2014 Mar. 1991:528. WebDistal phalangeal enchondromas are rare and often difficult to differentiate from epidermal cysts, glomus tumor and osteoid osteoma. See the Medscape Reference article Salter-Harris Fracture Imaging for more information. 1995 Jul-Aug. 15(4):422-5. The overall sensitivity of elbow US was 88%. Battle J, Carmichael KD. The deforming forces that act on the middle phalanx fractures are the FDS and the intrinsic tendons. (A) Initial anteroposterior view shows typical medial displacement of the capitellum and forearm bones. The double density caused by such overlap may simulate a flake of bone, with lucency of the physis simulating an adjacent fracture line. In some cases, cubitus varus results from medial comminution and collapse. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. In supracondylar fractures with medial displacement of the distal fragment, there is often internal rotation, which results in varus if the fracture is oblique. 92(17):2785-91. This motion causes the ulna to fracture and contact the proximal radius, forcing the radial head to become dislocated from the capitellum. Pediatr Radiol. The thumb also has several nerves that give you feeling and blood vessels that provide the thumb with blood flow. People with a history of bone disease or calcium deficiency are especially at risk for thumb fractures.

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