Humeral shaft fractures pediatric orthopaedic society of. They are frequently caused by a fall on an outstretched elbow or a direct blow to the elbow. Supracondylar fracture fractured humerus physioadvisor. A supracondylar fracture is an injury to the humerus, or upper arm bone, at its narrowest point, just above the elbow. Supracondylar fracture of the humerus emergency department.
Lateral and ap view of two year old girl with gartland type ii supracondylar fracture. The specific etiology of supracondylar humerus fractures in children is not well known. Analysis of early neurovascular complications of pediatric. Neurapraxia is a common complication of supracondylar fractures and usually resolves on its ownthus, treatment is observation only. Hyperextension of the elbow causes an extension type supracondylar fracture seen in 95% of cases. Of all complications associated with supracondylar fractures, nerve injury ranks. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. The perfused, pulseless supracondylar humerus fracture is urgent and ideally goes to the operating room immediately or within a few hours of presentation. To compare the clinical outcomes of 2 procedures, closed or miniopen reduction with percutaneous pinning orpp, for the treatment of supracondylar fractures of the humerus in children. Flexion supracondylar humeral fractures account for only 24% of all supracondylar fractures 1. Jan 15, 2012 arterial damage is sometimes associated with supracondylar fractures of the humerus. Gartlands classification of supracondylar fracture of humerus galeazzi fracture a fracture of the radius with dislocation of the distal radioulnar joint colles fracture a distal fracture of the radius with dorsal posterior displacement of the wrist and hand smiths fracture a distal fracture of the.
The aim of this study was to determine the prevalence and outcome of supracondylar fractures. It has been estimated that they account for approximately 65% of all fractures and dislocations in children. Pdf paediatric supracondylar fractures of the humerus. Gartlands classification of supracondylar fracture of humerus. Gartland type iii supracondylar fracture humerus 1630 2 the management of supracondylar fracture of humerus is controversial and technically difficult and complications are common. Supracondylar fracture pediatric pediatrics orthobullets. Flexion supracondylar fracture radiology reference article. This is an enhanced pdf from the journal of bone and joint surgery. Supracondylar fractures are the most common type of upper arm injury in children. A particular subset of pediatric extremity vascular injuries is the pink pulseless hands associated with supracondylar humerus fractures. Nerve injuries associated with pediatric supracondylar humeral fractures. Neurovascular complications after supracondylar humerus. On lateral view the anterior humeral line is anterior to the middle of capitellum.
Supracondylar fractures constitutes approximately 50% of all fractures. Supracondylar fractures of the distal humerus are a commonly encountered injury in children. Upon presentation, physicians should screen for neurovascular compromise and always be mindful of nonaccidental injuries. The most frequent fracture pattern at the elbow in children is the supracondylar humerus fracture with an incidence of around 316. There is an intervening thin area of bone connecting the olecranon fossa and coronoid fossa, which is the location of most supracondylar humerus fractures. Aug 23, 2019 distal humerus fractures in adults are relatively uncommon injuries, representing only about 3% of all fractures in adults. The association with neurovascular compromise and the potential problems of accurately reducing a displaced fracture can make treatment difficult particularly for the unwary surgeon. Fracture severity based on classification does not predict outcome. The classical treatment of displaced supracondylar humeral. A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. Swollen, painful elbow with decreased range of motion. Supracondylar fractures of the humerus in children clinical. Introduction supracondylar humerus fracture shf is one of the commonest fractures in pediatric elbow. Vascular compromise can be caused by arterial rupture, kinking, compression, spasm or intimal lesion and incidence increases depending on the degree of dislocation 7.
Simple supracondylar fractures are typically seen in younger children, and are uncommon in adults. Distal humerus orif fracture early motion therapy protocol. The anatomic location of the fracture, fracture pattern transverse, oblique, spiral, and amount and direction of angulation and displacement are criteria used to describe fractures. Kids broken elbow supracondylar fracture bone talks. Nerve injuries associated with pediatric supracondylar.
These fractures of the distal humerus are frequently problematic in terms of diagnosis, treatment, and complications. Unlike the much more common extension supracondylar fracture which are seen in children, flexion fractures are seen in older patients. Supracondylar humeral fractures, often simply referred to as supracondylar fractures, are a classic pediatric injury which require vigilance as imaging findings can be subtle. Supracondylar fractures of the humerus in children dr. Distal humerus fractures orthopaedic trauma association. Gartland classification modified type 1 nondisplaced.
Most common elbow fractures seen in children 5 to 6yrs boys vs gals 3. Age and severityadjusted treatment of proximal humerus fractures. Biomechanical analysis between orthofix external fixator and. The backslab and sling should be placed under figure 2. Anatomic articular reduction and provisional fixation as much as possible 2. A cubitus varus deformity may occur due to a malunion of the fracture. Supracondylar humerus fractures pediatric orthopaedic. This is the most common upper extremity fracture pattern in younger children, and the vascularinjury rate is as high as 10%. Supracondylar humerus fracture, open reduction, surgical approach. Pediatric supracondylar humerus fractures request pdf. Patients with medial epicondyle fractures and those with.
Orthopedics abstractsupracondylar fractures of the humerus in children are either flexion or extension in type. Analysis of early vascular and nerve complications of supracondylar humerus fractures in children. 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. Feb 07, 2018 fracture reduction and fixation should be done emergently in cases of vascular compromise. Nowadays closed reduction and percutaneous pinning has become standard of care for majority of displaced supracondylar humerus fractures. Supracondylar humerus fractures and brachial artery injuries. But in rare cases when there is too much force with the fall like seen when falling off the monkeybars, our muscles that bend the elbow.
Figure 1 relevant anatomy for a supracondylar fracture. Treatment of neer type 4 impacted valgus fractures of the proximal. Associated injuries in adjacent joints may be noted. True anteroposterior and lateral radiographs are essential not only for an accurate diagnosis, but also for creating a treatment plan for these injuries.
On the ap view, fracture lines can be seen through the metaphyseal bone of the distal humerus on either side of the olecranon fossa. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. Diagnosis and careful management of the fracture and arterial repair is crucial. Surgical treatment of supracondylar humerus fractures in children. Elastic stable intramedullary nailing of humerus fractures in children. If you continue browsing the site, you agree to the use of cookies on this website. Fracture supracondylar humerus some important facts. Pdf on jan 1, 2011, breck lord and others published paediatric supracondylar fractures of the humerus. Functional bracing of fractures of the shaft of the humerus. Supracondylar fractures of the humerus are the most common type of elbow fracture in children. All supracondylar humerus fractures treated at childrens hospital and health center, san diego chsd over. The extension type occurs when a child completely straightens their arm to brace for a fall, which sounds normal enough, and in most cases nothing happens. In a study of 4536 consecutive fractures in adults seen in the massachusetts general hospital emergency department, only 0. Appropriate age and mechanism of injury are highly suggestive factors when diagnosing a pediatric humeral fracture.
About 810% of children with supracondylar fracture of the humerus have an associated injury of the brachial artery, 2. An injury around the elbow where fracture line runs just above the coronoid and radial fossa transversely sparing the epicondyles. The majority of these fractures are supracondylar humeral. Supracondylar fractures of the humerus in children youtube. Mdct assessment of proximal humeral fracture according to.
Supracondylar humeral fracture radiology reference. Supracondylar and lateral condyle fractures of the humerus in. Fractures of the distal humerus are the most common humeral fracture in children 5. The large number of articles, extensive body of literature and numerous treatment proposals reflect the importance of this fracture 14. Supracondylar fracture of the humerus is the second most common fracture in children 16.
Anatomy of the distal humerus includes medial and lateral columns. Arterial damage accompanying supracondylar fractures of the. Each broad category further subdivided into 9 specific fracture types. Raise the arm on a pillow when sitting or lying down loose fitting clothing, not through the sleeve. This study was conducted to determine whether proximal humerus fracture patterns as defined by the orthopaedic trauma association aoota classifi. To compare the clinical outcomes of 2 procedures, closed or miniopen reduction with percutaneous pinning orpp, for the treatment of supracondylar fractures of. Fashion removable longarm splint holding the elbow in 90 degrees of.
Further research of humerus fractures is likely to have an important impact. Jul 28, 2018 supracondylar fracture of the distal humerus is a common fracture in the pediatric population, accounting for approximately 60% of all fractures of the elbow. Sickkids parent information sheet supracondylar humerus fracture without displacement. Pdf supracondylar fracture of the humerus in children. Welcome to the world of supracondylar fractures fracture of children not scary but spectacular it is a great teacher teaches you the values of basics in orthopedics it is kind and forgiving if you make a mistake cubitus varus, it forgives you no functional impairment but will not allow you to forget cosmetic disability in its. Distal humerus fracture open reduction and internal fixation. Aug 23, 2019 the clinical presentation of a supracondylar humerus fracture schf is that of a painful swollen elbow that the patient is hesitant to move.
Since1948, swenson firstly described two kwires of different sizes for closed reduction of supracondylar humerus fractures. Ebraheims educational animated video describing supracondylar fractures of the distal humerus in children. Open reductions of paediatric supracondylar humerus fractures. Supracondylar humeral fracture radiology reference article. Provisional internal fixation of articular surface to shaft 3.
Humeral shaft fractures account for approximately 20% of fractures of the humerus in children. Patients with supracondylar fractures will often have prolonged period months of inability to fully extend their elbow. New surgical methods for humerus fracture care have been introduced and widespread. This does not cause functional disability and should not be treated with physiotherapy. The elbow may appear angulated and the upper extremity shortened. Sep 21, 20 supracondylar fracture humerus in children slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. May 10, 2008 supracondylar fractures of the humerus are a common pediatric elbow injury that can be associated with neurovascular complications and skeletal deformity. Pediatric supracondylar fractures of the distal humerus. Understanding the anatomy, radiographic findings, complications, and management options associated with this fracture allow physicians to limit the morbidity associated with this injury. Proximal humerus fractures were treated conservatively in 41% and. A supracondylar fracture is a relatively uncommon condition involving a break in the upper arm bone humerus figure 1 just above the elbow joint.
Any information contained in this pdf file is automatically generated from. Supracondylar fractures are the most common pediatric elbow fracture and carry significant potential for neurovascular compromise. Fractures of the proximal humerus are a common major health problem for all the. Application of contoured plates in buttress fashion no. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters.
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