In 1956, lipscomb noted that supracondylar fractures were the cause of 48% of volkmanns contractures in 92 cases from the mayo clinic. Complications of supracondylar fractures of the elbow. A particular subset of pediatric extremity vascular injuries is the pink pulseless hands associated with supracondylar humerus fractures. These fractures of the distal humerus are frequently problematic in terms of diagnosis, treatment, and complications. Supracondylar fracture, pulseless hand, pediatric, brachial. Supracondylar humerus fractures and brachial artery injuries. A supracondylar fracture is best seen on a side view because in a supracondylar fracture the arm bone bends backward. Silva et al studied the interobserver reliability ieor and intraobserver reliability iaor of the baumann angle of the humerus a simple, repeatable measurement that can determine outcome of supracondylar humerus fractures schfs in children. They result in an extraarticular fracture line, and when displaced posterior displacement of the distal component.
Supracondylar fractures are the most common pediatric elbow fracture and carry significant potential for neurovascular compromise. Supracondylar humerus fracture wikipedia republished wiki 2. Gartlands classification of supracondylar fracture of humerus. Anatomy of the distal humerus includes medial and lateral columns. The most common complication was loss of carrying angle of more than 10 degrees, which occurred in three. The treatment of pediatric supracondylar humerus fractures. Eighteen injuries 82% were graded excellent or good, and there were two each with fair or poor outcomes. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles.
The most common complication was loss of carrying angle of more than 10 degrees, which. In children, many of these fractures are nondisplaced and can be treated with. Supracondylar fracture of the humerus is a common childhood injury to the elbow. Supracondylar fractures of the humerus in children. Underreduced supracondylar fracture of the humerus in children. Treatment of displaced supracondylar fracture of the humerus in children by open pining from lateral approach. The fracture subtypes with medial condyle, lateral condyle, and intercondylar extensions were classified based on radiographs. If the fracture is completely displaced at the distal humerus, the arm assumes an sshaped deformity fig. Based on the severity of the break the injury is classified as a gartland type 1, 2, or 3. All supracondylar humerus fractures treated at childrens hospital and health center, san diego chsd over. The perfused, pulseless supracondylar humeral fracture. Supracondylar and lateral condyle fractures of the humerus in. Immobilisation in an aboveelbow backslab in 90 degrees elbow flexion with sling for 3 weeks. Typically supracondylar fractures occur as a result of a fall on a hyperextended elbow.
This was a retrospective analysis of patient records and radiographs. Pediatric supracondylar humerus fractures with pulseless. The supporting evidence is lacking and requires the work group to make a recommendation based on expert opinion by considering the known potential harm and benefits associated with the treatment. Status post closed reduction and percutaneous pinning of this displaced supracondylar humerus fracture. The specific etiology of supracondylar humerus fractures in children is not well known. The elbow fracture was approached from the medial side, and atemporary screw was. Supracondylar fracture of the humerus emergency department. Supracondylar fractures of the humerus in children clinical. The association with neurovascular compromise and the potential problems of accurately reducing a displaced fracture can make treatment difficult. Pdf vascular complications of supracondylar humeral. Most common elbow fractures seen in children 5 to 6yrs boys vs gals 3. Boast supracondylar fractures in the humerus in children. Supracondylar fractures of the humerus are a common pediatric elbow injury that are historically associated with morbidity due to malunion, neurovascular complications, and compartment syndrome. A free powerpoint ppt presentation displayed as a flash slide show on id.
This fracture commonly occurs after a fall on an outstretched arm. Supracondylar fracture pediatric pediatrics orthobullets. Epidemiological analysis of displaced supracondylar fractures. There is an intervening thin area of bone connecting the olecranon fossa and coronoid fossa, which is the location of most supracondylar humerus fractures.
Despite being the most common fracture of the elbow in children, highquality scientific data regarding the treatment of pediatric supracondylar humerus fractures are lacking. Scribd is the worlds largest social reading and publishing site. These fractures are the result of trauma to the elbow, most often from a fall from height monkey bars are a common culprit, or other sports or leisure activities. The majority of supracondylar humeral fractures are extensiontype fractures 9799% resulting from a fall on. Radiographs of the elbow show a displaced supracondylar fracture. Fractures are classified as either an extension or flexiontype fracture.
Nondisplaced fracture may have limited swelling, but child will refuse to move arm ttp of posterior, distal humerus if evidence of sshape configuration or skin dimpling, splint before xray. Pediatric population predisposed, especially during ages when the supracondylar bone is undergoing skeletal maturation and has a thin and weak cortex. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture. This angle was measured by five observers on ap radiographs of 35 elbows that had sustained a nondisplaced. A supracondylar humerus sch fracture is the most common type of elbow fracture in children. Supracondylar fractures are the most common fracture of the elbow in children. Supracondylar fractures in children final authorstream presentation.
Supracondylar fracture leader among the injuries around elbow. Kids broken elbow supracondylar fracture bone talks. Dec 18, 2017 supracondylar fracture of the humerus is a common childhood injury to the elbow. Supracondylar humerus fracture wikipedia republished. Supracondylar humerus fracture sch is common in the pediatric age group 57 years, mostly due to a fall on an outstretched hand. Supracondylar fracture of the humerus shf is a common childhood injury, accounting for up to 70% of all pediatric elbow fractures. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. If treated quickly, either by immobilizing with a cast or. Supracondylar humerus fracturessupracondylar humerus fractures flexion typeflexion type rare, only 2%rare, only 2% distal fracture fragmentdistal fracture fragment anterior,flexedanterior,flexed ulnar nerve injury higherulnar nerve injury higher incidenceincidence reduce with extensionreduce with extension 78. Proper care requires appropriate assessment and prompt orthopedic care for those patients whose. Pulseless arm in association with totally displaced supracondylar fracture. It occurs at the bottom part of the humerus bone figures 1a and 1b. Supracondylar fracture leader among the injuries around elbow in children, incidences of fractures around the elbow region injuries percentage supracondylar fractures 65.
May 10, 2008 if the fracture is completely displaced at the distal humerus, the arm assumes an sshaped deformity fig. It usually follows a fall on an outstretched hand abbreviated as foosh, and patients experience elbow pain and swelling. These fractures of the distal humerus are frequently problematic in terms of diagnosis, treatment, and complications 1. Supracondylar fractures are one of the most common fracture patterns sustained by children, and one of the most common injuries requiring operative fixation.
Supracondylar humerus fracture wikimili, the free encyclopedia. The backslab and sling should be worn under clothing e. Ebraheims educational animated video describing supracondylar fractures of the distal humerus in children. Humeral supracondylar fracture an overview sciencedirect. Associated injuries 5% have associated distal radius fracture physical exam of distal forearm radiographs if needed if displaced pin radius also supracondylar. Supracondylar humeral fracture radiology reference article. Complications may include injury to an artery or nerve, and compartment syndrome the cause of a humerus fracture is usually physical trauma such as a. She had been taken to a neighboring hospital where a sterile dressing had been.
Supracondylar fractures of the humerus in children youtube. How safe is the operative treatment of gartland type 2 supracondylar humerus fractures in children. Demographic data, mechanism of injury like fall on outstretched hand foosh, fall on flexed elbow, side of injury, presence of open fracture, grade of fracture, flexion versus extension type of fracture, displacement of. Skaggs dl, sankar wn, albrektson j, vaishnav s, choi pd, kay rm. Pediatric supracondylar fractures of the distal humerus. Supracondylar fracture of humerus in children free download as powerpoint presentation. In children, many of these fractures are nondisplaced and can be. A humerus fracture is a break of the humerus bone in the upper arm. Cureus epidemiological analysis of displaced supracondylar.
A pucker, dimpling, or ecchymosis of the skin just anterior to the distal humerus may indicate that the proximal, anteriorly directed fragment has penetrated the brachialis muscle and possibly the subcutaneous layer as well fig. Open reduction and internal fixation for supracondylar humerus fractures in children. Displaced supracondylar fractures of the humerus how is. One hundred fortythree displaced type iii supracondylar fractures of the humerus in children were treated over a 5. They may be difficult to manage and can be associated with significant complications including nerve injury, vascular compromise, malunion and compartment syndrome. Complications may include injury to an artery or nerve, and compartment syndrome. Also note location of sulcus for ulnar nerve in relation to placement of medial plate, as well as location of radial nerve sulcus in relation to proximal placement of plates. Fracture that involves the epiphyseal plate or growth plate of a bone type i. Supracondylar humerus fractures pediatric orthopaedic. She is neurovascularly intact and the skin shows no evidence of open wounds. Supracondylar fractures of the distal humerus are a commonly encountered injury in children. Displaced supracondylar humerus fractures in children. Anteroposterior ap and lateral xrays of the distal humerus not elbow should be ordered if a supracondylar fracture of the humerus is suspected.
Of the 44 included studies in this clinical practice guideline, only 7 were rcts. Classification of supracondylar fractures is relatively straightforward and based on three types 67. Supracondylar humeral fracture radiology reference. She had been taken to a neighboring hospital where a sterile dressing had been applied to the open wound at the elbow, and the extremity had been splinted with an. The remaining three had persistent absence of radial pulse. The outcome of the operation was independent of the time interval between the trauma and the operation as well as the mode of transportation p 0. The association with neurovascular compromise and the potential problems of accurately reducing a displaced fracture can make treatment difficult particularly for the unwary surgeon. In this retrospective study of patients with type iii supracondylar humeral fractures, closed reduction and casting resulted in significantly fewer good results and more complications. Supracondylar humerus fractures comprise 65% of fractures around the elbow joint in the pediatric population.
Supracondylar fracture definition of supracondylar fracture. May 10, 2008 supracondylar fractures of the humerus are a common pediatric elbow injury that are historically associated with morbidity due to malunion, neurovascular complications, and compartment syndrome. Displaced supracondylar fractures of the humerus listed as dsfh. Biomechanical analysis of pin placement for pediatric. Open supracondylar fracture of the humerus jama jama. Supracondylar fractures humerus linkedin slideshare. Sep 21, 20 supracondylar humerus fractures supracondylar humerus fractures flexion typeflexion type rare, only 2%rare, only 2% distal fracture fragmentdistal fracture fragment anterior,flexedanterior,flexed ulnar nerve injury higherulnar nerve injury higher incidenceincidence reduce with extensionreduce with extension 78.
Open supracondylar fracture of the humerus jama network. Management of supracondylar fractures of humerus with. Supracondylar fractures of the distal humerus are the most common fractures about the elbow seen in children. It has been estimated that they account for approximately 65% of all fractures and dislocations in children. This analysis of supracondylar fractures examined the clinically important aspects. This analysis of supracondylar fractures examined the clinically important aspects including vascular. The patient had fallen from a horse, striking the left elbow, approximately one hour before admission.
If treated quickly, either by immobilizing with a cast or by surgery, the prospects for full recovery are very good. Sep 23, 2019 a supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. Posteromedia l vs posterolateral biceps tendon insertion and axis of muscle pull lies medial to the shaft of the humerus during fall onto an outstretched supinated arm, the forces applied tend to disrupt the posteromedial periosteum first and. Note medial and lateral columns, connected by trochlea, thus forming triangle of distal humerus.
There may be a decreased ability to move the arm and the person may present holding their elbow. However, a bilateral sch is rarely observed in this age group. It is displaced supracondylar fractures of the humerus. Loudest pubic bone crack ive ever heard self cracker gets deeper adjustmentcarpal tunnelasmr duration. Supracondylar humerus fractures are the most common type of elbow fracture in children. Diagnosis is made via xray showing elbow effusion, an anterior fat pad sign sail sign, and a posterior fat pad sign. Supracondylar fractures in children final authorstream. During the physical exam, examine the entire child and check for any signs of deformity in the other limbs. Of the 97 supracondylar fractures in this study, 55 56. Prognostic factors for the outcome of supracondylar. Prognostic factors for the outcome of supracondylar humeral. The approach ismade from the side ofthe smaller condylar fragment. Understanding the complications associated with supracondylar fractures is vital for the practicing orthopedic surgeon.
Pdf supracondylar fracture of the humerus in children. A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. Thereafter the management isthat ofan uncomplicated supracondvlar. This is the most common upper extremity fracture pattern in younger children, and the vascularinjury rate is as high as 10%. Ppt pediatric supracondylar humerus fracture powerpoint. True anteroposterior and lateral radiographs are essential not only for an accurate diagnosis, but also for creating a treatment plan for these injuries. Gartland classification modified type 1 nondisplaced. Supracondylar and lateral condyle fractures of the humerus. Supracondylar humerus fracture is the most common pediatric elbow fracture.
1152 487 257 643 459 248 1465 1162 1316 573 896 775 1129 502 1046 1521 222 491 921 220 273 1554 505 60 158 533 834 859 141 1481 756 1487 681 83 255 859 1030 287 330 837 547 1205 918 1263 847