Understanding the anatomy, radiographic findings, complications, and management options associated with this fracture allow physicians to limit the morbidity associated with this injury. Locking plate and fibular allograft augmentation in unstable. Fractures of the proximal humerus are common and most often treated. Postoperative pain control after supracondylar humerus. As the median and radial nerves lie anterior to the supracondylar humerus region they are at risk for injury, primarily posttrauma either by stretching, piercing or impinging at the fracture ends or being entrapped. These fractures of the distal humerus are frequently problematic in terms of diagnosis, treatment, and complications. Orthopedics abstractsupracondylar fractures of the humerus in children are either flexion or extension in type. 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. This is a ppt presentation on supracondylar fractures of the humerus for both undergraduates,postgraduates and young orthopedic.
Reduction of supracondylar fracture humerus in children s harwant, frcs ed, t a borban, frcs ed, university putra malaysia, institute of orthopaedics andtraumatology, hospitalkualalumpur, 50586jalanpahang, kualalumpur introduction the supracondylar fracture ofthe humerus in children is a common injuryworldwide and is noted to be a 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. Pediatric population predisposed, especially during ages when the supracondylar bone is undergoing skeletal maturation and has a thin and weak cortex. 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 complications. Fracture that involves the epiphyseal plate or growth plate of a bone type i. Fractures are classified as either an extension or flexiontype fracture. Displaced proximal humeral fractures remain difficult to treat, mainly because achieving stable fixation that maintains intra operative reduction is unpredictable. Complications of fracture supracondylar humerus include compartment syndrome, vascular injury, nerve injury fracture related or iatrogenic and malunion with cubitus varus deformity. This angle was measured by five observers on ap radiographs of 35 elbows that had sustained a nondisplaced supracondylar humerus fracture. Gartlands classification of supracondylar fracture of humerus. While some injuries might be humerus shaft fractures, a fracture just above these epicondyles is called a supracondylar fracture of the humerus. The full text of this article is available in pdf format. 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.
The incidence of compartment syndrome is approximately 0. The mechanism leading to this fracture is most often a fall on the hand with fully extended elbow primary treatment of dislocated fractures is closed reduction and percutaneous pinning with kirschnerwires kwires. Children typically are between ages 5 and 7 years, and boys and girls are affected equally. Anatomy of the distal humerus includes medial and lateral columns. Supracondylar humerus fractures are a common injury in children and account for approximately 15% of all pediatric fractures. We retrospectively evaluated 217 patients who received closed reduction and percutaneous pinning of type ii or iii supracondylar humerus fractures at our institution from 2003 to 2009. Purpose displaced pediatric supracondylar humerus fracture schf requires a. Treatment is usually closed reduction and percutanous pinning crpp, with the urgency depending on whether the hand remains perfused or not. 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. Functional and quality of life outcome after nonoperatively. Intramedullary nailing for pathological fractures of the proximal. 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.
Proper care requires appropriate assessment and prompt orthopedic care for those patients whose fractures pose the greatest risk. Supracondylar fractures are the most common pediatric elbow fracture and carry significant potential for neurovascular compromise. This page includes the following topics and synonyms. They are frequently caused by a fall on an outstretched elbow or a direct blow to the elbow. Supracondylar humerus fractures pediatric orthopaedic. Supracondylar fractures of the humerus in children dr. Proximal humerus, threepart fracture, fourpart fracture, surgical treatment, orif. Supracondylar fractures in children final authorstream presentation. An injury around the elbow where fracture line runs just above the coronoid and radial fossa transversely sparing the epicondyles.
Treatment tactics of transcondylar and supracondylar fractures of humerus complicated by peripheral circulation disturbances in children. Cheng1 reported it to be the second most common fracture in childhood 16. Distal humerus anatomy medial epicondyle proximal to trochlea lateral epicondyle proximal to capitellum radial fossa accommodates margin of radial head during flexion coronoid fossa accepts coronoid process of ulna during flexion. Management of proximal humeral fractures based on current. Supracondylar humerus fractures are the most common elbow fracture in children and account for 3% to 18% of all pediatric fractures. Supracondylar fracture of humerus in children free download as powerpoint presentation. Nowadays closed reduction and percutaneous pinning has become standard of care for majority of displaced supracondylar humerus fractures. Complications of supracondylar fractures of the elbow.
Introduction supracondylar humerus fracture shf is one of the commonest fractures in pediatric elbow. Proximal humerus, paediatric patient, retrograde elastic stable intramedullary nailing. Treatment tactics of transcondylar and supracondylar. Supracondylar humerus fracture archives international. Reproducibility of three classifications of proximal humeral fractures. The purpose of this study was to investigate the epidemiology of paediatric patients sustaining supracondylar humeral fractures, to identify common mechanisms of injury and to corroborate the anecdotal evidence that fractures occur more frequently during school holidays. True anteroposterior and lateral radiographs are essential not only for an accurate diagnosis, but also for creating a treatment plan for these injuries. Supracondylar and lateral condyle fractures of the humerus. The perfused, pulseless supracondylar humerus fracture is urgent and ideally goes to the operating room immediately or within a few hours of presentation. Nerve lesions in proximal humeral fractures rijnland orthopedie. Abstract the article is devoted to uptodate diagnostic methods and surgical correction of transcondylar and.
Fractures of the supracondylar process of the humerus r. Surgical treatment of three and fourpart proximal humeral 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. Pdf consensus and different perspectives on treatment of. 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. Scribd is the worlds largest social reading and publishing site. The role of nerve exploration in supracondylar 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. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles.
Purpose supracondylar fractures of the humerus are the most common fracture of theelbow in children. Supracondylar fractures in children final authorstream. The supracondylar humerus fracture schf is one of the most common fractures in children, predominantly the extensiontype. Supracondylar fractures are the most common type of upper arm injury in children. Displaced supracondylar humerus fractures in children. Studies have shown that these fractures occur commonly in children aged between 510 years and up to. Ebraheims educational animated video describing supracondylar fractures of the distal humerus in children. Proximal humerus fractures in children and adolescents emconsulte. Fracture supracondylar humerus some important facts. The majority of supracondylar humeral fractures are extensiontype fractures 9799% resulting from a fall on. Fracture reduction and fixation should be done emergently in cases of vascular compromise. Gartland classification of supracondylar humeral fractures.
A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. Fractures of the supracondylar process of the humerus. Two major classifications a according to the direction of. Neurovascular complications after supracondylar humerus. This is an enhanced pdf from the journal of bone and joint surgery. Consensus and different perspectives on treatment of supracondylar fractures of the humerus in children.
The humerus is the bone that makes up the upper portion of the arm. Pediatric supracondylar fractures of the distal humerus. Supracondylar fractures of the humerus are a common pediatric elbow injury that can be associated with neurovascular complications and skeletal deformity. It applies to extension supracondylar fractures rather than the rare flexion supracondylar fracture. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. Supracondylar fractures of the humerus are the most common fracture of the elbow in children. Ideal sources for wikipedia s health content are defined in the guideline wikipedia. Supracondylar humeral fractures, often simply referred to as supracondylar fractures, are a classic pediatric injury which require vigilance as imaging findings can be subtle. Pdf supracondylar fractures of the humerus in children. The ulnar nerve with its posterior location is uncommonly involved with a typical extensiontype supracondylar fracture.
Nunley, md, durham, nc the supracondylar process of the humerus is a relatively rare but wellknown anatomic variant that can be associated with other anomalies. These fractures are classified using the modified gartland. Supracondylar humeral fracture radiology reference. In addition to the fracture of the distal part of the humerus, four patients had a dislocation. Neurapraxia is a common complication of supracondylar fractures and usually resolves on. It has two thickened projections where it joins the elbow called epicondyles. Proximal humerus fractures are the seventh most common fracture in frequency and correspond to approximately 80% of all humeral fractures1. 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 fracture of the humerus is the second most common fracture in children 16. Supracondylar fracture fractured humerus physioadvisor. Supracondylar fracture of humerus, humeral supracondylar fracture, supracondylar fracture at elbow. Karin stenstrom accepts responsibility for the integrity and validity of the data. A proximal humerus fracture is a fracture at or proximal to the surgical neck of hu merus.
Upper extremity fractures account for up to 90% of pediatric fractures. Controlled compression nailing for at risk humeral shaft fractures. Supracondylar fractures of the distal humerus are a commonly encountered injury in children. The humerus is the second most common site for long bone metastases following the femur.
Supracondylar fractures constitutes approximately 50% of all fractures. Only a few studies exist concerning traction injury of nerves in fractures of the proximal humerus after lowvelocity trauma. 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. Open reductions of paediatric supracondylar humerus. It has been estimated that they account for approximately 65% of all fractures and dislocations in children. Distal humerus fracture above the epicondyles and above the physis pathophysiology supracondylar region of the humerus is the weakest part of the elbow humerus flattens, and widens. Girls tended to sustain these fractures more often. The neer classification for proximal humerus fractures is based on 4 fracture parts. The efficacy of side arm traction in the reduction of. Supracondylar fracture pediatric pediatrics orthobullets. Traitement chirurgical des fractures supracondyliennes.
Supracondylar fractures of the humerus in children youtube. 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. The nondominant hand, usually the left hand, is more commonly injured. Republican research centre of emergency medicine rrcem, tashkent, uzbekistan. Simple supracondylar fractures are typically seen in younger children, and are uncommon in adults. Supracondylar humerus fracture, open reduction, surgical approach. Supracondylar fractures of the humerus in children. Supracondylar fractures of the humerus have been recognised since the time of hippocrates and are one of the more common fractures in children. 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.
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