Dec 18, 2017 a supracondylar fracture is an injury to the humerus, or upper arm bone, at its narrowest point, just above the elbow. Supracondylar fractures of the humerus are a common pediatric elbow injury that can be associated with neurovascular complications and skeletal deformity. This is called a supracondylar supra con dy ler humerus 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.
Anatomy of the distal humerus includes medial and lateral columns. Supracondylar fractures of the humerus have been recognised since the time of hippocrates and are one of the more common fractures in children. Upper extremity fractures account for up to 90% of pediatric fractures. Supracondylar fractures of the humerus in children british. The following exercises are commonly prescribed to patients with a supracondylar fracture following confirmation that the fracture has healed, and that the orthopaedic specialist has indicated it is safe to begin mobilization. His left arm took the brunt and had severe pain and swelling in his left elbow after the injury. Gartland classification of supracondylar humeral fractures. Supracondylar humerus fractures and brachial artery injuries.
Purpose supracondylar fractures of the humerus are the most common fracture of theelbow in children. Fracture that involves the epiphyseal plate or growth plate of a bone type i. Pdf upper extremity fractures account for up to 90% of pediatric 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. It is not intended for use in pediatric patients who present with additional coexisting injuries that require formal surgical intervention or other lifethreatening conditions that take precedence over the treatment of the supracondylar fracture of the humerus. Supracondylar humerus fractures are the most common elbow fracture in children and have the highest complication rate for elbow fractures in this age group. Supracondylar humerus fractures pediatric orthopaedic. The guidelines further recommend postoperative radiographs should be. Supracondylar fractures of the humerus in children youtube. Displaced supracondylar humerus fractures that are associated with neurologic andor vascular injuries are treated with timely reduction through closed techniques.
Supracondylar humeral fracture radiology reference article. Management of supracondylar fractures of the humerus in children. Sickkids parent information sheet supracondylar humerus fracture without displacement. Before the age of two, the low supracondylar fracture is an entity to beware of, as the largely unossified distal humeral chondroepiphysis renders radiological. Supracondylar fractures of the humerus in children longdom. This is the most common upper extremity fracture pattern in younger children, and.
All supracondylar humerus fractures treated at childrens hospital and health center, san diego chsd over. Supracondylar humeral fractures account for 60 percent of fractures near the elbow among children. The treatment of pediatric supracondylar humerus fractures. Radiographs of the elbow show a displaced supracondylar fracture. Fracture, supracondylar humerus childrens hospital colorado. The humerus hu mer us bone is the long, thick bone in the upper arm that extends from the shoulder to the elbow. Supracondylar fracture of the humerus is the most common fracture around the elbow in children 1,2. Simple supracondylar fractures are typically seen in younger children, and are uncommon in adults. He attends the local emergency department and is informed that he has a supracondylar fracture of his humerus.
Children with a displaced supracondylar fracture of the distal humerus. This does not cause functional disability and should not be treated with physiotherapy. Supracondylar humerus fractures are the most common elbow injury in pediatric patients. The pulseless supracondylar fracture remains an emergency 8, 9. Severely displaced humeral supracondylar fracture gartland iii carries the risks of neurovascular injury and compartment syndrome 5. A shaftcondylar angle and a lateral capitellohumeral angle, which can. Gartland type iii supracondylar fracture humerus 1630 2 the management of supracondylar fracture of humerus is controversial and technically difficult and complications are common.
The main goals of surgical treatment of supracondylar humerus fractures schfs are as follows. Clinical practice guideline on the treatment of pediatric supracondylar humerus fractures clinical practice guidelines cpg provide evidence based recommendations for current orthopaedic diagnostic, treatment, and postoperative procedures. Pediatric supracondylar fractures of the distal humerus. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. Objective the incomplete supracondylar fracture of distal humerus poses difficulty for diagnosis. Raise the arm on a pillow when sitting or lying down loose fitting clothing, not through the sleeve. Supracondylar humeral fracture radiology reference. The specific etiology of supracondylar humerus fractures in children is not well known. Overview supracondylar humeral fractures account for 60 percent of fractures near the elbow among children. Oct 01, 2018 the socalled floating elbow occurs when the supracondylar fracture of the humerus is associated with an ipsilateral forearm fracture. Among these fractures supracondylar humerus fractures are one of the. It accounts for 17% of all limb fractures in children 3,4. There may be a decreased ability to move the arm and the person may present holding their elbow. 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 fractures are the most common type of upper arm injury in children. Treatment of displaced supracondylar fracture of humerus in. Supracondylar fracture of the humerus is the most common fracture around the elbow in children. We then discuss the diagnosis of a supracondylar fracture and the treatment of a supracondylar fracture using easy to understand language and if you have an questions, please email us as we are happy to help. Complications of supracondylar fractures of the elbow. Appropriate use criteria auc provide treatment recommendations on a patientspecific level using evidence from aaos clinical practice guidelines, along with clinician expertise and experience. Understanding the anatomy, radiographic findings, complications, and management options associated with this fracture allow physicians to limit the morbidity associated with this injury. This is an uncommon situation approximately 5% of the supracondylar fractures that reflects highenergy trauma. 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 type 3c distal humerus fracture 5 months after injury and fixation using olecranon osteotomy approach and medial and. Lateral and ap view of two year old girl with gartland type ii supracondylar fracture.
It occurs at the bottom part of the humerus bone figures 1a and 1b. Application of clinical pathway using electronic medical record system in pediatric patients with supracondylar fracture of the humerus. Supracondylar humerus fracture what is a supracondylar fracture. When closed techniques fail, reduction by open methods is indicated. It is not intended for use in pediatric patients who present with additional coexisting injuries that require formal surgical intervention or other lifethreatening conditions that take precedence over the. In a study of 4536 consecutive fractures in adults seen in the massachusetts general hospital emergency department, only 0. Gartland classification modified type 1 nondisplaced. 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. Supracondylar fracture teachmesurgeryteachmesurgery. Supracondylar fractures are the most common pediatric elbow fracture and carry significant potential for neurovascular compromise. A total of 107 cases of supracondylar fracture of the humerus in children. On lateral view the anterior humeral line is anterior to the middle of capitellum. Supracondylar fracture of the humerus is the second most common fracture in children 16. 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.
On the ap view, fracture lines can be seen through the metaphyseal bone of the distal humerus on either side of the olecranon fossa. Gartlands classification of supracondylar fracture of humerus. Aug 23, 2019 distal humerus fractures in adults are relatively uncommon injuries, representing only about 3% of all fractures in adults. These fractures are classified using the modified gartland. 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. 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. Multidisciplinary clinician work groups and aaos staff work together to synthesize published research. Girls tended to sustain these fractures more often. Children more commonly suffer from this fracture than adults and it may cause serious complications if ignored. Supracondylar fractures may have significant complications including nerve injury, vascular injury, malunion and compartment syndrome 3. We use your linkedin profile and activity data to personalize ads and to show you more relevant ads. Appropriate use criteria of pediatric supracondylar humerus fractures. Supracondylar fracture of the humerus emergency department. 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. In the printed or pdf version of this article, author affiliations can be found at the bottom of. Proper care requires appropriate assessment and prompt orthopedic care for those patients whose fractures pose the greatest risk. Open reduction techniques for supracondylar humerus.
Distal humerus fractures including supracondylar fractures are often both comminuted and intraarticular. She is neurovascularly intact and the skin shows no evidence of open wounds. A humerus fracture is a break of the humerus bone in the upper arm. Supracondylar fractures are the most common fracture of the elbow in children. Your childs humerus is fractured broken near the elbow area, just above the joint. Treatment is usually closed reduction and percutanous pinning crpp, with the urgency depending on whether the hand remains perfused or not. Supracondylar humeral fractures are a common paediatric elbow injury, but are almost never seen in adults the peak age of incidence is between 57 years. Humeral supracondylar fracture an overview sciencedirect. Anterior to the supracondylar area of the distal humerus is the median nerve. 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. Anatomic articular reduction and provisional fixation. Ebraheims educational animated video describing supracondylar fractures of the distal humerus in children.
Jan 28, 2019 supracondylar fracture occurs commonly in distal humerus. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. Supracondylar fractures of the humerus are the most common type of elbow fractures in children, accounting for 5070% of all fractures about the elbow. 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. Supracondylar humerus fractures are the most common elbow fractures in children. Severely displaced humeral supracondylar fracture gartland iii carries the risks. Supracondylar humerus fracture nationwide childrens. Supracondylar humerus fracture patient safety checklist. The backslab and sling should be placed under figure 2. Supracondylar fractures are very common in children and account for about 60% of all paediatric elbow fractures. A particular subset of pediatric extremity vascular injuries is the pink pulseless hands associated with supracondylar humerus fractures.
Pdf humeral supracondylar fractures are the second most common fractures seen in children and young teenagers 16. Type 5 is a type 4 with fracture of medial condyle osteoporoticbone can be associated with undisplaced supercondylar fx. A documented assessment of the limb, performed on presentation. Patients with supracondylar fractures will often have prolonged period months of inability to fully extend their elbow. The second recent trend is that divergent lateral pinning has replaced cross pinning, reducing ulnar nerve injuries. 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. Kids broken elbow supracondylar fracture bone talks. Supracondylar fractures of the distal humerus are a commonly encountered injury in children. A supracondylar fracture is an injury to the humerus, or upper arm bone, at its narrowest point, just above the elbow. Pediatric supracondylar humerus fractures journal of hand surgery. Supracondylar fracture pediatric pediatrics orthobullets. Of the 44 included studies in this clinical practice guideline, only 7 were rcts.
Pdf supracondylar humerus fractures in children wendy. Pdf management of supracondylar fractures of the humerus in. Appointments no pt for 3 weeks, unless otherwise specified by md rehabilitation goals modalities to control pain and swelling protect fracture site maintain rom in surrounding joints prevent deconditioning. These fractures of the distal humerus are frequently problematic in terms of diagnosis, treatment, and complications. Among these fractures supracondylar humerus fractures are one of the commonest requiring surgical intervention and have a high prevalence of associated short term complications such as nerve injuries and long term complications such as cubitus varus. In many academic centers the treatment of the supracondylar humerus fractures is performed exclusively by the pediatric orthopedic surgeons. During the 1950s, these injuries were called the misunderstood fracture, as such injuries often resulted in bony deformity and volkmanns contracture.
Cheng1 reported it to be the second most common fracture in childhood 16. A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. It applies to extension supracondylar fractures rather than the rare flexion supracondylar fracture. This is the most common upper extremity fracture pattern in younger children, and the vascularinjury rate is as high as 10%. Supracondylar fractures constitutes approximately 50% of all fractures. Supracondylar humeral fractures, often simply referred to as supracondylar fractures, are a classic pediatric injury which require vigilance as imaging findings can be subtle. In 1959, gartland described a simple classification scheme to reemphasize principles underlying treatment of patients with a. 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. Children aged seven years or older who sustain supracondylar humeral fractures tend to get more comminuted fractures. The gartland classification of supracondylar fractures of the humerus is based on the degree and direction of displacement, and the presence of intact cortex. True anteroposterior and lateral radiographs are essential not only for an accurate diagnosis, but also for creating a treatment plan for these injuries. Epidemiology simple supracondylar fractures are typically seen in yo. This type of elbow fracture is most common in children between the ages of two and eight years. Displaced supracondylar humerus fractures in children are they.
This fracture commonly occurs after a fall on an outstretched arm. Pdf supracondylar fractures of the humerus in children. A supracondylar humerus sch fracture is the most common type of elbow fracture in children. Pdf supracondylar fracture of the humerus in children.
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