Humeral supracondylar fracture an overview sciencedirect topics. 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. Typically supracondylar fractures occur as a result of a fall on a hyperextended elbow. According to cheng and colleagues 1999, supracondylar humerus. Surgical treatment of displaced supracondylar pediatric. For treatment of this fracture, closed reduction and percutaneous pinning, and open reduction and internal fixation were two common managements for supracondylar fracture. Biomechanical analysis of pin placement for pediatric. A, an anteriorposterior view shows a fairly subtle lucency through the distal humerus. This is the most common upper extremity fracture pattern in younger children, and the vascularinjury rate is as high as 10%. Supracondylar fractures of the humerus are a common pediatric elbow injury that can be associated with neurovascular complications and skeletal deformity.
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. Posteromedial displacement of the distal fragment is the most frequent. A particular subset of pediatric extremity vascular injuries is the pink pulseless hands associated with supracondylar humerus fractures. Evaluation and management of pulseless pinkpale hand syndrome. Supracondylar fractures of the humerus are the most frequent fractures of the paediatric elbow, with a peak incidence at the ages of five to eight years. Posterior fat pad sign lucency visible on the lateral view. Subtle signs on plain film radiograph for a supracondylar fracture include.
Supracondylar fractures of the humerus in children clinical. Simple supracondylar fractures are typically seen in younger children, and are uncommon in adults. Among closed supracondylar humeral fractures, the flexiontype injury pattern was associated with a 15. A humerus fracture is a break of the humerus bone in the upper arm. Supracondylar humerus fracture sch is common in the pediatric age group 57 years, mostly due to a fall on an outstretched hand. A fishtail deformity is one of the wellknown complications following pediatric lateral condyle or supracondylar fractures of the humerus.
Various common injuries in the shoulder, humerus, and elbow are investigated in this section. Pediatric supracondylar humerus fractures with pulseless. The gartland classification of supracondylar fractures of the humerus is based on the degree and direction of displacement, and the presence of intact cortex. In the uncomplicated distal humerus supracondylar and lateral condylar fractures, it takes 5 weeks to restore original elbow rom after removal of long arm cast without physical therapy.
True anteroposterior and lateral radiographs are essential not only for an accurate diagnosis, but also for creating a treatment plan for these injuries. Fracture that involves the epiphyseal plate or growth plate of a bone type i. Lateral and ap view of two year old girl with gartland type ii supracondylar fracture. Most patients recovered a useful range of movement and there were no complications. Pediatric supracondylar fractures of the distal humerus. Supracondylar humerus fractures that historically were treated with closed. In lowincome countries, where surgical expertise and resources are limited, displaced supracondylar fractures of the distal humerus are routinely managed with traction or closed reduction and casting. Results of treatment of displaced supracondylar humeral. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children.
Complications of supracondylar fractures include neurovascular injuries and deformity. In cases of pediatric supracondylar humerus fracture, early closed reduction and percutaneous pinning is preferred. Supracondylar fracture fractured humerus physioadvisor. To report the results of surgical management for latepresenting displaced supracondylar fractures of the humerus in children. Supracondylar humerus fractures schf are common injury in children and represent the most frequent fractures involving the elbow. The incidence rates of malunion cubitus varus and compartment syndrome have both.
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. Open reductions of paediatric supracondylar humerus. In complex fractures, ct can assist in delineating injuries. All supracondylar humerus fractures treated at childrens hospital and health center, san diego chsd over. Considering the possible complications involved including nerve deficit and compartment syndrome, documentation is crucial to good patient care. We use your linkedin profile and activity data to personalize ads and to show you more relevant ads. Patients with supracondylar fractures will often have prolonged period months of inability to fully extend their elbow. Delayed open reduction for supracondylar fractures of the. The annual rate of children who present with supracondylar fractures. Rotation of the distal fracture fragment in the supracondylar fracture is a contributing factor in the development of the cubitus varus deformity. Pdf supracondylar fractures of the humerus in children. Management of supracondylar fractures of the humerus in. Supracondylar humerus fractures is one of the commonest fractures in pediatric elbow. A patients guide to distal humerus fractures of the elbow.
On the ap view, fracture lines can be seen through the metaphyseal bone of the distal humerus on either side of the olecranon fossa. Babar, iu, shinwari, n, bangash, mr management of supracondylar fracture of humerus in children by close reduction and immobilization of the elbow in extension and supination. Supracondylar and lateral condyle fractures of the humerus. Nowadays closed reduction and percutaneous pinning has become standard of care for majority of displaced supracondylar humerus fractures. On lateral view the anterior humeral line is anterior to the middle of capitellum. The patient had fallen from a horse, striking the left elbow, approximately one hour before admission. Most common elbow fractures seen in children 5 to 6yrs boys vs gals 3. Aaos appropriate use criteria summary management of. Pediatric supracondylar fractures are one of the most common traumatic fractures see in children and most commonly occur in children 57 years of age, usually from a fall on an outstretched hand.
There may be a decreased ability to move the arm and the person may present holding their elbow. Conservative management of displaced paediatric supracondylar. Clinical and radiographic outcomes of supracondylar. This 4yearold female fell from a couch onto her outstretched hand, sustaining a supracondylar humeral fracture. While nondisplaced fractures can be managed nonoperatively, both closed and open surgical reduction techniques are indicated when fractures are displaced or associated with neurovascular injury. Twenty synthetic humeri were sectioned in the mid olecranon fossa to simulate a supracondylar humerus fracture. 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 humerus with crossed kwires via medial approach s hussain, ms orth, s dhar, ms orth, a qayoom, ms orth abstract this study aimed at evaluating the medial approach for open reduction and internal fixation of gartland type 3 displaced supracondylar fractures of humerus in children. The results of treatment of displaced supracondylar fractures of the humerus in.
Pediatric supracondylar humerus fracture is the property of its rightful owner. The occurrence of supracondylar fracture of the humerus account for 55 to 75% of patients with elbow fractures 3, 4. Kids broken elbow supracondylar fracture bone talks. Supracondylar fracture pediatric pediatrics orthobullets. A retrospective cohort study of pediatric patients with surgically managed supracondylar humerus fractures was conducted. Abstract the treatment of type ii and type iii supracondylar fractures of the humerus in children with closed reduction and percutaneous pinning has dramatically lowered the rate of complications from this injury. Supracondylar fracture of the humerus is a common elbow injury in children. Ap and lateral xrays of the elbow are usually obtained to evaluate these injuries. 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 fracture of the humerus is a common childhood injury to the elbow.
Supracondylar humeral fractures were twice as common in females in this very young cohort. Among these fractures supracondylar humerus fractures are one of the. Risk factors for vascular repair and compartment syndrome in the pulseless supracondylar humerus fracture in children. This is in contrast to highincome nations, where percutaneous kwire fixation forms the mainstay of treatment. Supracondylar fractures of the humerus are the most common fracture of the elbow in children. Displaced supracondylar fractures of the humerus in children may be managed with or without kirschnerwire fixation.
Supracondylar and lateral condyle fractures of the humerus in. 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. The mainstay of investigation for suspected supracondylar fractures is via plain film radiographs in both anteroposterior ap and lateral views of the elbow. The specific etiology of supracondylar humerus fractures in children is not well known.
Supracondylar humeral fracture radiology reference. Diagnosis and careful management of the fracture and arterial repair is crucial. Evidencebased information, in conjunction with the clinical expertise of physicians. Two thirds of all hospitaliza tions for elbow injuries in children are for supracondylar. A retrospective study comparing crossed and lateral wire. Supracondylar humerus fractures are common elbow injuries in children that occur in a vulnerable.
Usually closed reduction and percutaneous pinning is the preferred treatment for most of the displaced fractures. Anterior to the supracondylar area of the distal humerus is the median nerve. Supracondylar humeral fractures are a common paediatric elbow injury, but are almost never seen in adults the peak age of incidence is 57 years. Complications of supracondylar fractures of the elbow. 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. Flexion supracondylar humeral fractures account for only 24% of all supracondylar fractures 1. Supracondylar humeral fracture radiology reference article.
If treated quickly, either by immobilizing with a cast or by surgery, the. Supracondylar fractures of humerus with crossed kwires via medial approach s hussain, ms orth, s dhar, ms orth, a qayoom, ms orth abstract this study aimed at evaluating the medial approach for open reduction and internal fixation of gartland type 3 displaced supracondylar fractures of humerus in. We also found a nearly 5timeshigher odds of loss of reduction when fracture. Distal humerus fractures orif of supracondylar fractures. 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 fractures are the most common pediatric elbow fracture and the second most common pediatric fracture overall.
Classification of supracondylar fractures is relatively straightforward and based on three types 67. Supracondylar fractures of the humerus in children youtube. Humeral supracondylar fracture an overview sciencedirect. This does not cause functional disability and should not be treated with physiotherapy. This paper describes the techniques employed in the surgical treatment of pediatric supracondylar humerus fractures. Elbow region fractures are the most common injuries in children. Treatment is usually closed reduction and percutanous pinning crpp, with the urgency depending on whether the hand remains perfused or not. Supracondylar fracture of the humerus emergency department. These injuries interfere with the ability of the elbow to place the hand in a functional position. The recovery of elbow range of motion after treatment of.
The presence of an ulnar nerve injury at presentation resulted in an additional 6. Epidemiological analysis of displaced supracondylar fractures. 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. The most common mechanism of injury is falling on an outstretched hand with the elbow in extension a small percentage occur from landing directly onto a flexed elbow due to the close proximity of surrounding neurovascular. Jan 15, 2012 arterial damage is sometimes associated with supracondylar fractures of the humerus. Surgical management for late presentation of supracondylar. Gartlands classification of supracondylar fracture of humerus.
Pdf humeral supracondylar fractures are the second most common fractures seen in children and young teenagers. These fractures of the distal humerus are frequently problematic in terms of diagnosis, treatment, and complications. Supracondylar fractures in children final authorstream. Indications discuss indications and more general concerns. The humerus hu mer us bone is the long, thick bone in the upper arm that extends from the shoulder to the elbow. Supracondylar humeral fractures are common in the paediatric population and.
A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. She is neurovascularly intact and the skin shows no evidence of open wounds. Previously, surgery has been performed with an open ligament release and supracondylar process excision. May 10, 2008 supracondylar fractures of the humerus are a common pediatric elbow injury that can be associated with neurovascular complications and skeletal deformity. The aim of this study was to determine the prevalence and outcome of supracondylar fractures. This is called a supracondylar supra con dy ler humerus fracture. Extensiontype fractures represent 97% to 99% of cases. Ebraheims educational animated video describing supracondylar fractures of the distal humerus in children. They are usually asymptomatic but may produce clinical symptoms related to compression of the median nerve or brachial artery below the ligament. Although you may recognize this as a fracture, the degree of displacement appears minimal. It applies to extension supracondylar fractures rather than the rare flexion supracondylar fracture. Cheng1 reported it to be the second most common fracture in childhood 16. Understanding the anatomy, radiographic findings, complications, and management options associated with this fracture allow physicians to limit the morbidity associated with this injury.
Include any exams preformed under anesthesia positioning describe and provide or photos to illustrate p. Twenty children with grade iv supracondylar fractures of the humerus had an open reduction 11 to 17 days after injury. The humeral supracondylar process and struthers ligament comprise a relatively rare but wellknown anatomic variant. They result in an extraarticular fracture line, and when displaced posterior displacement of the distal component. Unlike the much more common extension supracondylar fracture which are seen in children, flexion fractures are seen in older patients. She had been taken to a neighboring hospital where a sterile dressing had been. Elbow fractures are typically associated with traumaa fall or motor vehicle accident are common causes. Documentation of neurovascular status in supracondylar. This analysis of supracondylar fractures examined the clinically important aspects including vascular. This information could be applied in the education material.
Open supracondylar fracture of the humerus jama jama network. Significant attention is paid not only to proper diagnostic examination and imaging, but also to optimal nonoperative and operative treatment options to manage these conditions. It has been estimated that they account for approximately 65% of all fractures and dislocations in children. If so, share your ppt presentation slides online with. Your childs humerus is fractured broken near the elbow area, just above the joint. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. Endoscopic excision of supracondylar humeral spur for. Gartland classification modified type 1 nondisplaced. Bone remodeling after supracondylar humeral fracture in children. The current treatment of displaced supracondylar fractures consists of closed reduction and. Dec, 2011 supracondylar fractures in children dept.
Application of clinical pathway using electronic medical record system in pediatric patients with supracondylar fracture of the humerus. Kanchana registrar in surgery teaching hospital peradeniya 2. The incidence of neurologic injury ranges from 5% to 19%. Supracondylar fractures constitutes approximately 50% of all fractures. 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. Radiographs of the elbow show a displaced supracondylar fracture. Supracondylar fracture of humerus in children free download as powerpoint presentation. Among them, supracondylar fractures of the humerus are the most frequent. Hyperextension of the elbow causes an extension type supracondylar fracture seen in 95% of cases.
The association with neurovascular compromise and the potential problems of accurately reducing a displaced fracture can make treatment difficult particularly for the unwary surgeon. 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. Pediatric supracondylar fractures of the distal humerus springerlink. Supracondylar fractures of the distal humerus are a commonly encountered injury in children. Treatment of supracondylar humerus and femoral shaft fractures has changed over time, leading to a decrease in the associated incidence of compartment syndrome following these injuries. This was the first childrens hospital admission for this 9 12yearold white female. Anatomy of the distal humerus includes medial and lateral columns.
Supracondylar fractures of the humerus sch are the most common fractures about the elbow in children that require operative stabilization. We herein report a case of medial condyle fracture kilfoyle type iii in an 11yearold boy. Supracondylar fractures of the humerus have been recognised since the time of hippocrates and are one of the more common fractures in children. See instructions for authors for a complete description of levels of evidence. Supracondylar fracture of the humerus is the second most frequent types of bone injury in children 1, 2. Sickkids parent information sheet supracondylar humerus fracture. The supracondylar fracture of the humerus in children remains the most challenging injury for the orthopedic surgeon. Complications may include injury to an artery or nerve, and compartment syndrome. No member of this panel participated in the writing panels initial development of the scenarios or participated in the voting panels appropriateness rating of. This is the most common upper extremity fracture pattern in younger children, and the vascularinjury rate is. Gentle closed manipulation under image intensification was attempted in all patients, except one with a compound open fracture. Children aged seven years or older who sustain supracondylar humeral fractures tend to get more comminuted fractures.
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. Supracondylar fractures of the humerus are a common pediatric elbow injury that are historically associated with morbidity due to malunion. Supracondylar humerus fractures and brachial artery injuries. Supracondylar fractures are the most common pediatric elbow fracture and carry significant potential for neurovascular compromise. For clinical outcomes analyses, 3 months of clinical followup were required, resulting in a sample size of 90 patients 33 treated by npos, 57 by pos.
Lateral and frontal views of a comminuted supracondylar. Pdf supracondylar fracture of the humerus in children. Arterial damage accompanying supracondylar fractures of the. Supracondylar humerus fractures pediatric orthopaedic. Supracondylar fractures in children final authorstream presentation. An analysis of varying pin size, number and lateral starting points has not previously been performed. Medial condyle fracture kilfoyle type iii of the distal.
There is an intervening thin area of bone connecting the olecranon fossa and coronoid fossa, which is the location of most supracondylar humerus fractures. It is important to consider the options of treatment very carefully and tailor the treatment according to the characteristics of. Understanding the complications associated with supracondylar fractures is vital for the practicing orthopedic surgeon. These fractures affect mainly the male gender and occur prevalently in consequence of an extension mechanism 4. Comparison of lateral versus tricepssplitting posterior. Gartland classification of supracondylar humeral fractures. Supracondylar humeral fractures are the second most common fracture type in children. Supracondylar fracture teachmesurgeryteachmesurgery.
The flexion recovered last among 4 directions in supra and lateral condylar fractures. Supracondylar humerus fractures are one of the most common fractures in children and account for 60%. Introduction fracture of distal humerus which is proximal to bone masses of the trochlear and capitulum. Flexion supracondylar fracture radiology reference article. 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. Aaos appropriate use criteria summary management of pediatric supracondylar humerus fractures abstract the american academy of orthopaedic surgeons has developed appropriate use criteria auc on the management of pediatric supracondylar humerus fractures pshf.