This type of elbow fracture is most common in children between the ages of two to eight years. Pdf supracondylar fracture of the humerus in children. Supracondylar fracture pediatric pediatrics orthobullets. Supracondylar humeral fracture radiology reference. Excellent outcome in the form of range of motion can be obtained even if the fracture has lost the reduction. Palmar flexion injuries with wrist acutely palmar flexed 5%. In 1883, stimson first described the fracture patterns in lateral condyle fractures in his book treatise on fractures. Original article to compare the outcome of patients with. Our longterm study showed that the fixation pins do not disturb the growth potential of the distal end of the humerus.
Management of lateral humeral condylar mass fractures in. Epidemiologic pattern of paediatric supracondylar fractures. Humerus supracondylar type i ae 3 weeks supracondylar type ii or iii displaced call orthopedics operative neck undisplaced stevenson young, fu prn 6 weeks stevenson x 4 weeks no sports for 8 weeks older, 4 weeks neck displaced call orthopedics only if older stevenson young, 4 weeks older, 1 week shaft stevenson young, 4 weeks. Pdf supracondylar fractures of the humerus in children. Early reports of childrens fractures lumped the areas fractured together, and fractures were reported only as to the long bone involved e. Supracondylar fracture of humerus is the most common paediatric elbow fracture, constituting about 15% of all paediatric fractures and more than half of paediatric elbow fractures. Sep 23, 2019 a supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. For 150 years, families have come from around the corner and across the world, looking to boston children s for answers. Pain management of pediatric musculoskeletal injury in the. Full text of rockwood and wilkins fractures in children. Supracondylar fracture of humerus closed reduction 45. Glossary this leaflet is based on the work of the welsh child.
Most supracondylar fractures are shown to best advantage on the lateral elbow radiograph. Dorsiflexion injuries with wrist dorsiflexed 95% b. This risk is increased in children less than 2 years of age as a result of the unique aspects of the infants vasculature. Predisposing effect of elbow alignment on the elbow. Transverse this is a straightline fracture across the bone. This paper describes the techniques employed in the surgical treatment of pediatric supracondylar humerus fractures. After supracondylar fracture, distal humerus epiphyseal fracture is the second most frequent injury of the elbow 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. Management of supracondylar fractures of the humerus in.
Anatomy ossification general prinicples supracondylar fractures lateral condyle fractures medial epicondyle avulsion proximal radius fractures radial head dislocations nursemaids elbow paediatric elbow fractures. Radiographs at fracture union have little prognostic value. Anatomy of the distal humerus includes medial and lateral columns. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture. Management of vascular injuries in displaced supracondylar humerus fractures without arteriography. The supracondylar fracture of humerus in children is the most common fracture and has different methods of. For the goldstandard resource on pediatric fractures, reach for rockwood and wilkins fractures in children. Pdf supracondylar humerus fractures in children wendy. May 10, 2008 supracondylar fractures of the humerus are a common pediatric elbow injury that can be associated with neurovascular complications and skeletal deformity. Montreal childrens hospital mcgill university health. Scribd is the worlds largest social reading and publishing site. Lateral condylar mass lcm fractures of the distal humerus comprise 17% of distal humeral fractures and are the second most common injury around the elbow in the paediatric population, after supracondylar fractures. Lateral condyle fractures of the elbow are the second most common paediatric elbow fracture after supracondylar fractures. In infants, it is difficult to distinguish accidental from abusive skull fractures because.
The incidence occurs in a bimodal distribution, with peaks in early childhood and midadolescence. She is neurovascularly intact and the skin shows no evidence of open wounds. This should intersect the middle third of the capitellum. Lateral condyle fracture of the humerus in children. The following guidelines are for use in the fracture clinic. They account for 1220% of elbow fractures in children. Supracondylar humerus fracture wikimili, the free encyclopedia. How to identify fractures that may be the result of child abuse. If the force of the impact is excessive, the bone may fracture at or near the site of the impact and cause damage to the underlying structures within the skull such as the membranes, blood vessels, and brain. Physical findings the child with a supracondylar fracture typically has elbow pain, swelling, and very. Orthopedics operative time is a critical driver of cost in orthopedics and an important target for improving value in health care. The distal fracture fragment is displaced and often angulated posteriorly. Pediatric supracondylar fractures of the distal humerus. Boys 42 % girls 27 % percentage of children sustaining a fracture in one year.
Supracondylar fracture of humerus complications 46. Closed reduction and kwires fixation in supracondylar. Under the hypothesis that the elbow alignment, key words. Overview supracondylar fractures are one of the most common traumatic fractures see in children and most commonly occur in children 57 years of age from a fall on an outstretched hand treatment is usually closed reduction and percutanous pinning crpp, with the urgency depending on whether the hand remains perfused or not. Displaced supracondylar humerus fractures in children schf have a high risk of fracture or treatmentrelated complications. This leaflet summarises what is currently known about fractures in children and when to be concerned that. In early childhood, the most common mechanism is a simple fall or twisting injury. Lateral condyle fracture of the humerus in children treated. This is the place where the most difficult challenges are faced head on, where the impossible becomes possible, and where families in search of answers find them. As such, extension supracondylar humerus fractures account for nearly two thirds of all pediatric hospitalizations from elbow trauma. Pain management for children with musculoskeletal injuries is suboptimal and, in the absence of clear evidencebased guidelines, varies significantly. Predisposing effect of elbow alignment on the elbow fracture.
The severity of the fracture is graded from 1 to 3. A skull fracture is a break in one or more of the eight bones that form the cranial portion of the skull, usually occurring as a result of blunt force trauma. Simple supracondylar fractures are typically seen in younger children, and are uncommon in adults. Supracondylar fractures of the humerus are a common pediatric elbow injury that can be associated with neurovascular complications and skeletal deformity. It is simply an outgrowth of bone that occurs along the anteromedial surface of the distal humerus and is typically oriented toward the joint, whereas pedunculated osteochondromas are oriented away from the joint fig. After 35 days of sidearm traction, swelling had usually diminished sufficiently to allow the elbow to be safely hyperflexed to stabilize the fracture after elective closed reduction. The dinner fork technique for treating displaced lateral condylar fractures of the humerus in children. Closed reduction and kwires fixation in supracondylar fracture humerus in children muhammad khalid ur rehman, roomana akhlaque, anwar ahmed abstract background.
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. Understanding the anatomy, radiographic findings, complications, and management options associated with this fracture allow physicians to limit the morbidity associated with this injury. Before the age of two, the low supracondylar fracture is an entity tobewareof, as thelargely unossi. Supracondylar fracture of humerus in children free download as powerpoint presentation. The pulseless supracondylar fracture remains an emergency 8, 9. A spiral or oblique fracture of the shaft of the humerus is more likely to be due to abuse than accidental causes in young children, but a supracondylar fracture is highly suggestive of accidental injury.
Written by leading orthopaedic surgeons from around the world, the revised and expanded 8th edition of this classic bestselling text presents. Supracondylar humerus fractures pediatric orthopaedic. Radiographs of the elbow show a displaced supracondylar fracture. Spiral fractures can also occur accidentally in the femur once the child is walking. Upper extremity fractures account for up to 90% of pediatric fractures. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. Varus deformity was prevented by avoiding medial tilt of the distal fragment. This fracture commonly occurs after a fall on an outstretched arm. Evaluation and management of supracondylar fractures in children. The supracondylar fracture of humerus in children is the most common fracture and has different methods of treatment.
Jan 03, 2019 in 1883, stimson first described the fracture patterns in lateral condyle fractures in his book treatise on fractures. Cubitus varus, when it occurred, was a result of imperfect reduction rather than growth disturbance. Epiphyseal fractures of the distal humerus are described in relation to their location. Glossary this leaflet is based on the work of the welsh. We undertook a retrospective study of 39 children with displaced supracondylar fractures treated by delayed closed reduction with fluoroscopic guidance. Montreal childrens hospital mcgill university health center. He described the fracture as beginning in the lateral metaphysis proximal to the condyle, coursing distally, and exiting through the articular surface through the medial trochlear notch or through the capitellotrochlear groove. Gartland proposed a useful classification for supracondylar fractures. For femoral fractures, the probability was between 0. A supracondylar humerus sch fracture is the most common type of elbow fracture in children.
Supracondylar fractures of the humerus in children. The function of the quadriceps muscle after a fracture of the femur in patients who are less than seventeen years old. Supracondylar fractures of the humerus account for 55% to 80% of total elbow fractures in children and up to twothirds of paediatric elbow injuries requiring hospitalization. Apr 01, 2008 the pulseless supracondylar fracture remains an emergency 8, 9. Neonatal transphysial supracondylar fracture detected by ultrasound. Blind pinning of displaced supracondylar fractures of the. Supracondylar this refers to a fracture of the upper arm, fracture of humerus immediately above the elbow. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. Predisposing effect of elbow alignment on the elbow fracture type in children seungcheol kang, md and soosung park, md, phd objectives. If distal humerus is displaced backwards, it will intersect more anteriorly. For 150 years, families have come from around the corner and across the world, looking to boston childrens for answers.
Management of lateral humeral condylar mass fractures in children. This leaflet summarises what is currently known about fractures in children and when to be concerned that a child may have been physically abused. Epidemiology of fractures in children musculoskeletal key. These fractures have a peak incidence at the age of 57 years, with boys more affected. Analysis of fracture type showed that supracondylar humeral fractures were less likely to be inflicted. A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint.
In many academic centers the treatment of the supracondylar humerus fractures is performed exclusively by the pediatric orthopedic surgeons. This study used an archetypal pediatric orthopedic procedure to. 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. Epidemiology of fractures in children early reports of childrens fractures lumped the areas fractured together, and fractures were reported only as to the long bone involved e.
Among these fractures supracondylar humerus fractures are one of the commonest requiring surgical intervention and have a. The supracondylar process of the humerus may be easily mistaken for an osteochondroma. The thoroughly revised, updated seventh edition of rockwood and wilkins fractures in children offers a complete print and multimedia package. Hennrikus wl, kasser jr, rand f, millis mb, richards km. Of all the fracture in upper limb the supracondylar fracture of humerus is not only the most common injury but can result in serious complications if not treated appropriately. Femoral shaft diaphysis tibial shaft diaphysis ankle distal tibial and fibula physeal. Lateral condyle fracture of the humerus emergency department. There were 355 elbow fractures, and there were 164 boys 46% and 191 girls 54%.