Kanchana registrar in surgery teaching hospital peradeniya 2. Biomechanical analysis of pin placement for pediatric supracondylar humerus fractures. 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 inflatable splint. Children more commonly suffer from this fracture than adults and it may cause serious complications if ignored. The presence of a narrow anterior fat pad aka sail sign can be normal. A particular subset of pediatric extremity vascular injuries is the pink pulseless hands associated with supracondylar humerus fractures. What are the potential complications associated with this injury. He had a transient fishtail deformity of the trochlear groove after open reduction and internal fixation. A total of 107 cases of supracondylar fracture of the humerus in children were examined after a followup period of 8 to 18 years.
In children with supracondylar fracture the most often injured nerve is median nerve. Supracondylar fractures of the humerus are the most common fracture of the elbow in children. Supracondylar humerus fractures are one of the most common fractures in children and account for 60%. She had been taken to a neighboring hospital where a sterile dressing had been. Complications, gartland classification, pediatric, pediatric elbow fracture, supracondylar humerus fracture. Humeral supracondylar fracture an overview sciencedirect. They may be difficult to manage and can be associated with significant complications including nerve injury, vascular compromise, malunion and compartment syndrome. Analysis of early vascular and nerve complications of supracondylar humerus fractures in children. It accounts for 17% of all limb fractures in children 3,4. 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. Distal humerus fractures orif of supracondylar fractures. Gartland classification modified type 1 nondisplaced. A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint.
Supracondylar fracture of the humerus is the second most common fracture in children 16. These fractures of the distal humerus are frequently problematic in terms of diagnosis, treatment, and complications. He presented to our clinic 1 week post injury with moderate soft tissue swelling, ecchymosis and intact skin. The purpose of this study was to evaluate, in terms of outcomes and complications, gartland type iii pediatric supracondylar humerus fractures treated at a pediatric levelone trauma center over a 7year period, specifically addressing the impact of time to surgery on the incidence of. Sickkids parent information sheet supracondylar humerus fracture without displacement. Supracondylar fractures are the most common type of upper arm injury in children. All supracondylar humerus fractures treated at childrens hospital and health center, san diego chsd over. An analysis of varying pin size, number and lateral starting points has not previously been performed. Supracondylar and lateral condyle fractures of the humerus.
Supracondylar humeral fractures are the second most common fracture type in children. Flexion supracondylar humeral fractures account for only 24% of all supracondylar fractures 1. Complications of supracondylar fractures include neurovascular injuries and deformity. This is the most common upper extremity fracture pattern in younger children, and the vascularinjury rate is as high as 10%. An ap and lateral view of the humerus revealed a long spiral fracture of the distal 14 of the humerus with an associated large spiral butterfly fragment. Include any exams preformed under anesthesia positioning describe and provide or photos to illustrate p. Supracondylar fractures of the humerus in children.
In the proximal forearm, the anterior interosseous branch separates to innervate the flexor profundus to the index finger and the flexor pollicis longus and then terminates with the innervation of the pronator quadratus. Supracondylar humerus fracture orthopedics medbullets. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. 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. These fractures require open reduction and pin fixation.
Supracondylar humeral fracture radiology reference article. Epidemiology simple supracondylar fractures are typically seen in yo. Flexion supracondylar fracture radiology reference. Diagnosis and careful management of the fracture and arterial repair is crucial. On the ap view, fracture lines can be seen through the metaphyseal bone of the distal humerus on either side of the olecranon fossa. Article pdf available january 2016 with 2,534 reads. Supracondylar humerus fracture sch is common in the pediatric age group 57 years, mostly due to a fall on an outstretched hand. There may be a decreased ability to move the arm and the person may present holding their elbow. Materials and methods between july 2011 and june 2012, 17 children admitted to hospital universiti kebangsaan malaysia with closed supracondylar humeral fractures of gartland types 2 and 3 were treated using this technique. Analysis of early neurovascular complications of pediatric. Application of clinical pathway using electronic medical record system in pediatric patients with supracondylar fracture of the humerus. The annual rate of children who present with supracondylar fractures. Dec, 2011 supracondylar fractures in children dept.
Supracondylar fracture, humerus, external fixator, kirschner wire introduction supracondylar fracture of the humerus is the most common fracture around the elbow in children 1,2. Computed tomography ct is superior to conventional radiography in the assessment of the position of fracture fragments and was used to study 20 patients with supracondylar fractures after reduction. Supracondylar fractures of the humerus are one of the most common fractures of childhood. Pdf supracondylar fracture of the humerus in children. The specific etiology of supracondylar humerus fractures in children is not well known. Hyperextension of the elbow causes an extension type supracondylar fracture seen in 95% of cases. We use your linkedin profile and activity data to personalize ads and to show you more relevant ads. This is called a supracondylar supra con dy ler humerus fracture. Arterial damage is sometimes associated with supracondylar fractures of the humerus. There is an intervening thin area of bone connecting the olecranon fossa and coronoid fossa, which is the location of most supracondylar humerus fractures. Nowadays, closed reduction and percutaneous pinning crpp is the most. Posterior fat pad sign lucency visible on the lateral view. The purpose of this study was to evaluate, in terms of outcomes andcomplications, gartland type iii pediatric supracondylar humerus fractures treated at apediatric levelone trauma center over a 7year period, speci. With the recognised complications of cubitus varus, injury to any of the three major nerves around the elbow, absent radial pulse after fracture reduction, stiffness and the fortunately rare incidence of volkmanns ischaemic contracture, an appropriate understanding of the pathology and management of this.
Supracondylar fractures of the humerus in children are the result of trauma to the elbow, most often a fall from height or related to sports or leisure activities. Open supracondylar fracture of the humerus jama jama network. 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. Supracondylar fractures are the most common pediatric elbow fracture and carry significant potential for neurovascular compromise. It is also the commonest pediatric fracture around the elbow. Aug 23, 2019 distal humerus fractures in adults are relatively uncommon injuries, representing only about 3% of all fractures in adults. 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 fall. Supracondylar fractures of the humerus are a common pediatric elbow injury that can be associated with neurovascular complications and skeletal deformity.
The patient had fallen from a horse, striking the left elbow, approximately one hour before admission. Supracondylar humerus fractures shf comprise 17% of all pediatric fractures and are second in frequency to forearm fractures. It has been estimated that they account for approximately 65% of all fractures and dislocations in children. Pediatric supracondylar fractures of the distal humerus. In a study of 4536 consecutive fractures in adults seen in the massachusetts general hospital emergency department, only 0. Ct scan demonstrated that this fracture was extraarticular.
The mainstay of investigation for suspected supracondylar fractures is via plain film radiographs in both anteroposterior ap and lateral views of the elbow. Jan 15, 2012 arterial damage is sometimes associated with supracondylar fractures of the humerus. She is neurovascularly intact and the skin shows no evidence of open wounds. Introduction fracture of distal humerus which is proximal to bone masses of the trochlear and capitulum. Supracondylar fractures of the distal humerus are a commonly encountered injury in children.
This was the first childrens hospital admission for this 9 12yearold white female. Supracondylar fractures constitutes approximately 50% of all fractures. Purpose supracondylar fractures of the humerus are the most common fracture of theelbow in children. Results of treatment of displaced supracondylar humeral fractures in. Supracondylar fracture of the humerus emergency department. Supracondylar humerus fractures are common elbow injuries in children that occur in a vulnerable. Anatomy of the distal humerus includes medial and lateral columns. These fractures are classified using the modified gartland. Among these fractures supracondylar humerus fractures are one of the. Unlike the much more common extension supracondylar fracture which are seen in children, flexion fractures are seen in older patients. 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. Supracondylar fractures of the distal humerus are the most common fractures about the elbow seen in children. Supracondylar fracture of the humerus is one of the most common injuries in children.
Indications discuss indications and more general concerns. Seventy children with displaced type ii and iii supracondylar fractures of the humerus were managed with percutaneous lateral crosswiring. Ap and lateral xrays of the elbow are usually obtained to evaluate these injuries. The humerus hu mer us bone is the long, thick bone in the upper arm that extends from the shoulder to the elbow. Biomechanical analysis of pin placement for pediatric. The incidence of vascular and nerve complications positively correlates with the progression of fracture according to gartland classification. Arterial damage accompanying supracondylar fractures of the. Although you may recognize this as a fracture, the degree of displacement appears minimal. May 10, 2008 supracondylar fractures of the humerus are a common pediatric elbow injury that can be associated with neurovascular complications and skeletal deformity. Between february 2002 and june 2003, 40 children mean age, 7 years with late presentation range, 212 days of displaced supracondylar humeral fractures were prospectively recruited.
Medial condyle fracture kilfoyle type iii of the distal. Documentation of neurovascular status in supracondylar. A humerus fracture is a break of the humerus bone in the upper arm. Supracondylar humeral fracture radiology reference. Conservative treatment gave good results, and open reduction was seldom indicated.
Twenty synthetic humeri were sectioned in the mid olecranon fossa to simulate a supracondylar humerus fracture. The association with neurovascular compromise and the potential problems of accurately reducing a displaced fracture can make treatment difficult particularly for the unwary surgeon. Radiographs of the elbow show a displaced supracondylar fracture. Fracture that involves the epiphyseal plate or growth plate of a bone type i. Conservative management of displaced paediatric supracondylar. Supracondylar fracture of the humerus fracture clinics. 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. Anterior to the supracondylar area of the distal humerus is the median nerve. Rotation of the distal fracture fragment in the supracondylar fracture is a contributing factor in the development of the cubitus varus deformity. Supracondylar fracture directory of open access journals.
Supracondylar humerus fracture nationwide childrens. These fractures are more commonly seen in boys 4 these injuries are almost always due to accidental trauma, such as falling from a moderate height bedmonkeybars 4. Lateral and ap view of two year old girl with gartland type ii supracondylar fracture. Supracondylar fractures of the humerus sciencedirect. In complex fractures, ct can assist in delineating injuries. Supracondylar fracture occurs commonly in distal humerus. A fishtail deformity is one of the wellknown complications following pediatric lateral condyle or supracondylar fractures of the humerus. True anteroposterior and lateral radiographs are essential not only for an accurate diagnosis, but also for creating a treatment plan for these injuries. Supracondylar humerus fractures and brachial artery injuries. Simple supracondylar fractures are typically seen in younger children, and are uncommon in adults. Supracondylar fractures in children final authorstream. How often should these fractures be followed up in fracture clinics. Children aged seven years or older who sustain supracondylar humeral fractures tend to get more comminuted fractures.
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. Pediatric supracondylar humerus fracture shf is a complicated injury which can result in severe sequela. Supracondylar humerus fracture nationwide childrens hospital. Article information, pdf download for conservative management of. The aim of this study was to determine the prevalence and outcome of supracondylar fractures. Patients with supracondylar fractures will often have prolonged period months of inability to fully extend their elbow. Supracondylar fractures of the humerus occur at the distal portion of the humerus without involving the growth plate. Humeral supracondylar fracture an overview sciencedirect topics. Distal humeral fractures, posttraumatic elbow deformity, supracondylar osteotomy, surgical technique. Supracondylar and lateral condyle fractures of the humerus in. Proper care requires appropriate assessment and prompt orthopedic care for those patients whose fractures pose the greatest risk. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. Ebraheims educational animated video describing supracondylar fractures of the distal humerus in children.
Complications of supracondylar fractures of the elbow. Supracondylar fracture teachmesurgeryteachmesurgery. On lateral view the anterior humeral line is anterior to the middle of capitellum. Gentle closed manipulation under image intensification was attempted in all patients, except one with a.
Boast supracondylar fractures in the humerus in children. Jan 28, 2019 supracondylar fracture occurs commonly in distal humerus. Gentle closed manipulation under image intensification was attempted in all patients, except one with a compound open fracture. When should i refer for an orthopaedic consultant opinion. Supracondylar fractures in children final authorstream presentation. 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 displace the fragment posterolaterally.
Complications may include injury to an artery or nerve, and compartment syndrome. A, an anteriorposterior view shows a fairly subtle lucency through the distal humerus. Arterial damage accompanying supracondylar fractures of. Supracondylar fracture pediatric pediatrics orthobullets. Pdf humeral supracondylar fractures are the second most common fractures seen in children and young teenagers. Severely displaced humeral supracondylar fracture gartland iii. Open supracondylar fracture of the humerus jama jama. This 4yearold female fell from a couch onto her outstretched hand, sustaining a supracondylar humeral fracture. Management of supracondylar fractures of the humerus in children. Gartlands classification of supracondylar fracture of humerus. Supracondylar fractures of the humerus in children youtube. Surgical management for late presentation of supracondylar. Your childs humerus is fractured broken near the elbow area, just above the joint.
The incidence of neurologic injury ranges from 5% to 19%. We herein report a case of medial condyle fracture kilfoyle type iii in an 11yearold boy. Complications and predictors of need for return to the operating. This does not cause functional disability and should not be treated with physiotherapy. According to an epidemiological study, the incidence of fracture supracondylar humerus is 30800 per year in the general population.
Supracondylar osteotomies of posttraumatic distal humeral. A supracondylar fracture is an injury to the humerus, or upper arm bone, at its narrowest point, just above the elbow. Kids broken elbow supracondylar fracture bone talks. Understanding the anatomy, radiographic findings, complications, and management options associated with this fracture allow physicians to limit the morbidity associated with this injury. A 36yearold right hand dominant male sustained a twisting injury to his right upper extremity upon falling. Supracondylar humeral fractures, often simply referred to as supracondylar fractures, are a classic pediatric injury which require vigilance as imaging findings can be subtle.
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