The backslab and sling should be placed under figure 2. The elbow may appear angulated and the upper extremity shortened. Supracondylar humerus fracture nationwide childrens. Oct 11, 2017 when stratified by age, supracondylar humerus fractures represent the most common fracture among both infant to 3yearolds and 47yearolds. Theodore ghan, vc, department of emergency medicrne, ucsd medical certer, 8676. Specific findings for supracondylar fracture include. Pediatric supracondylar fractures of the distal humerus. T supracondylar fractures of the humerus occur rarely in children compared with the adult variety. Background supracondylar fractures are associated with a high incidence of neurovascular complications.
Surgical treatment results in pediatric supracondylar humerus. In late presentation of cases there is dilemma whether to wait for osteotomy later or do open reduction on arrival. The pshf auc clinical patient scenarios were derived from patient indications that generally accompany a pshf as well as from current evidencebased clinical practice guidelines and supporting literature. The objective of this metaanalysis was to illustrate the clinical outcomes and safety of two different managements for supracondylar humeral fractures in children. Read supracondylar fracture, journal of emergency medicine on deepdyve, the largest online rental service for scholarly research with thousands. Management of pediatric supracondylar humerus fractures heggeness, michael h. A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. Typei fractures were treated with immobilisation in an extension cast.
Extension injuries account for 95% of supracondylar fractures. This does not cause functional disability and should not be treated with physiotherapy. Treatment is usually closed reduction and percutanous pinning crpp, with the urgency depending on whether the hand remains perfused or not. Clinical practice guideline on the treatment of pediatric supracondylar humerus fractures. Supracondylar fractures in children are often associated with neurologic and vascular damage that must be recognized before fracture reduction. Note medial and lateral columns, connected by trochlea, thus forming triangle of distal humerus. Supracondylar fracture humerus journal of medical thesis. In these age groups, supracondylar humerus fractures comprise approximately 27 and 32% of fractures, respectively. The incidence of vascular and nerve complications positively correlates with the progression of fracture according to gartland classification. Full clinical practice guideline pdf on the treatment of pediatric supracondylar humerus fractures. Gartlands classification of supracondylar fracture of humerus. Most common elbow fractures seen in children 5 to 6yrs boys vs gals 3. Considering the possible complications involved including nerve deficit and compartment syndrome, documentation is crucial to good patient care.
This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. Particular care will be taken in children before distal humeral epiphyseal ossification e. Operative treatment of these fractures is a serious major procedure, not without danger, and preliminary planning and preparation of fixation materials are essential for success. Supracondylar humeral fracture radiology reference. In children with supracondylar fracture the most often injured nerve is median nerve. Biomechanical analysis of pin placement for pediatric. Supracondylar fractures of the humerus are the most common type of elbow fractures in children. This fracture commonly occurs after a fall on an outstretched arm.
Apr 01, 2014 the epidemiology of elbow fracture in children. Clinical practice guidelines cpg provide evidencebased recommendations for current orthopaedic diagnostic, treatment, and postoperative procedures. Nursing staff members skill with pediatric patients can greatly aid the surgeon in the timely and safe treatment of these fractures. According to cheng and colleagues 1999, supracondylar humerus fractures constitute approximately 18% of. Comprehensive clinical evaluation is a necessity when children with these injuries present to the emergency department. Raise the arm on a pillow when sitting or lying down loose fitting clothing, not through the sleeve.
Humeral supracondylar fracture an overview sciencedirect. Treatment of displaced supracondylar fracture of humerus in. Supracondylar humerus fractures are the most common elbow fracture in children and have the highest complication rate for elbow fractures in this age group. Recurrent fracture of the humerus due to sudden extreme muscular action. Supracondylar humerus fractures pediatric orthopaedic. Sixteen such fractures treated at the children s hospital of eastern ontario between 1975 and 1983 are described. Data on patients prepared for two different managements for.
This is the most common upper extremity fracture pattern in younger children, and the vascularinjury rate is as high as 10%. This is called a supracondylar supra con dy ler humerus fracture. Simple supracondylar fractures are typically seen in younger children, and are uncommon in adults. 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. Analysis of early neurovascular complications of pediatric. Neurovascular assessment can be difficult due to pain, anxiety and the young age of these patients. The purpose of this prospective multicentric study is to evaluate the functional outcome of open reduction and internal fixation orif with crossed kirschner wires fixation and early joint motion in the late presentation of supracondylar fractures in children. There is an intervening thin area of bone connecting the olecranon fossa and coronoid fossa, which is the location of most supracondylar humerus fractures. Schoenecker pl, delgado e, rotman m, sicard ga, capelli am. Radiographs of the elbow show a displaced supracondylar fracture. Supracondylar fractures the hospital for sick children. Anatomy of the distal humerus includes medial and lateral columns. Supracondylar fracture of the humerus is a common childhood injury to the elbow. Supracondylar fractures are divided into two types as extensor and flexor.
It occurs at the bottom part of the humerus bone figures 1a and 1b. For the more severe injuries, traction usually provides the best opportunity to observe the arm closely, control swelling, and gently effect reduction and fixation of the fracture, and it is preferable to eleva. Pulseless arm in association with totally displaced supracondylar fracture. Supracondylar fracture of the humerus is one of the most common injuries in children.
Supracondylar humerus fractures are one of the major pediatric elbow fractures that account for 55 to 80% of all upper limb fractures. The humerus hu mer us bone is the long, thick bone in the upper arm that extends from the shoulder to the elbow. Patients were treated with two different pin configurations, crossed group 1 and lateral group 2. The 220 patient scenarios and 14 treatments were developed by the. Supracondylar fracture directory of open access journals. Patients with supracondylar fractures will often have prolonged period months of inability to fully extend their elbow. If treated quickly, either by immobilizing with a cast or. Throwers fracture of the humerus mdedge emergency medicine. Complex fractures in their series were classified as type iii according to gartland, supracondylar humeral fractures with intercondylar. Supracondylar humerus fractures clinical presentation. Treatment of flexiontype supracondylar humeral fracture in. This technique, using high quality fluoroscopic imaging, allows for a near anatomical reduction of fractures without the need for an open surgical procedure or prolonged traction.
To assess the results of treatment for flexiontype supracondylar humeral fracture in children. Supracondylar humerus fractures occur most frequently in children ages 57 years. Traction summary supracondylar fractures of the humerus are one of the most common fractures of childhood. Supracondylar fractures of the humerus sch are the most common fractures about the elbow in children that require operative stabilization. Supracondylar humeral fractures are the second most common fracture type in children. 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 vascular complications of supracondylar humeral. Documentation of neurovascular status in supracondylar.
Severity was classified according to the gartland system for extensiontype fractures. The journal of the american academy of orthopaedic surgeons. Stans, in morreys the elbow and its disorders fifth edition, 2018. The treatment of displaced supracondylar humerus fractures. The journal of bone and joint surgery american volume 1978. The american academy of orthopaedic surgeons has developed the appropriate use criteria auc document management of pediatric supracondylar humerus fractures with vascular injury. A supracondylar humerus sch fracture is the most common type of elbow fracture in children. The specific etiology of supracondylar humerus fractures in children is not well known.
The aim of this study is to report the results of the treatment of displaced supracondylar humerus fractures comparing two different techniques, crossed and lateral pins. A particular subset of pediatric extremity vascular injuries is the pink pulseless hands associated with supracondylar humerus fractures. Supracondylar fractures humerus linkedin slideshare. Gartland classification modified type 1 nondisplaced. All paediatric patients who presented to the accident and emergency department with a supracondylar distal humerus fracture over the 3year period from 1 july 2008 to 30 june 2011 were included in the study. The auc clinical patient scenarios were derived from patient indications that generally accompany a pediatric supracondylar humerus fracture with vascular injury, as well as from current evidencebased clinical practice guidelines and supporting. There is complete displacement of the distal humerus anteriorly. 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. Sickkids parent information sheet supracondylar humerus. Supracondylar humerus fractures are the most common type of elbow fracture in children. Fracture that involves the epiphyseal plate or growth plate of a bone type i. Treatment of displaced supracondylar fracture of humerus.
Supracondylar fractures of the humerus have been recognised since the time of hippocrates and are one of the more common fractures in children. There were nine male and seven female patients, 717 years old. Supracondylar fractures of the humerus represent a significant burden of injuries in children, accounting for 1217% of all paediatric fractures 2. Supracondylar humerus fractures are the most common pediatric elbow fracture and the second most common pediatric fracture overall. One hundred fortythree displaced type iii supracondylar fractures of the humerus in children were treated over a 5. The clinical presentation of a supracondylar humerus fracture schf is that of a painful swollen elbow that the patient is hesitant to move. 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 humerus fractures comprise 65% of fractures around the elbow joint in the pediatric population. The metaphyseal flare of the distal humerus connects the diaphysis of the humeral shaft to the epiphysis. Supracondylar humerus fractures in children aorn journal. Evidencebased information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain the best outcomes while. Mba jaaos journal of the american academy of orthopaedic surgeons. In a study of 4536 consecutive fractures in adults seen in the massachusetts general hospital emergency department, only 0.
The fracture is a metaphyseal injury that does not involve the physis or. Extensiontype fractures are more frequent and particularly visible after palm falls when the elbow is hyperextended 3. Several studies have examined the biomechanical stability of smooth wire fixation constructs used to stabilize pediatric supracondylar humerus fractures. Some series report that open wounds are present in as many as 30% of these fractures. True anteroposterior and lateral radiographs are essential not only for an accurate diagnosis, but also for creating a treatment plan for these injuries. Supracondylar humeral fracture radiology reference article. Eight cases of supracondylar t fractures of the humerus have been treated by the operative procedure described, and their end results are illustrated. All supracondylar humerus fractures treated at childrens hospital and. A throwers fracture is a rare fracture pattern characterized by a spontaneous fracture of the mid to distal third of the humeral diaphysis during an attempted throwing motion.
Also note location of sulcus for ulnar nerve in relation to placement of medial plate, as well as location of radial nerve sulcus in relation to proximal placement of plates. Supracondylar fracture journal of education and teaching in emergency medicine. Pi1 so736467996 002545 visual diagnosis in emerglency medicine supracondylar theodore fracture chan, md department of emergency medune. The supracondylar fracture of the humerus is the mostcommon and the likely, when badly displaced, to be accompanied by vascular injury. Supracondylar fracture, journal of emergency medicine 10.
It was first described by wilmoth in a case report published in 1930. Surgical treatment of pulseless pediatric supracondylar. Aug 23, 2019 distal humerus fractures in adults are relatively uncommon injuries, representing only about 3% of all fractures in adults. Jan 10, 2017 neurovascular injury and displacement in type iii supracondylar humerus fractures. Surgical treatment of displaced supracondylar pediatric.
Supracondylar humerus fractures and brachial artery injuries. Supracondylar fracture pediatric pediatrics orthobullets. Ischaemia and the pink, pulseless hand complicating supracondylar fractures of the humerus in childhood. 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. Analysis of early vascular and nerve complications of supracondylar humerus fractures in children. She is neurovascularly intact and the skin shows no evidence of open wounds. Treatment of flexiontype supracondylar humeral fracture. Your childs humerus is fractured broken near the elbow area, just above the joint. Management of pediatric supracondylar humerus fractures. Cheng1 reported it to be the second most common fracture in childhood 16.
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