Dr. Ebraheim’s educational animated video describes Supracondylar fracture of the distal femur. The supracondylar region is the weakest point in the developing elbow and therefore is commonly injured. A CT scan is obtained which shows intra-articular extension of the fracture, and lateral locked plating with intercondylar lag screw fixation is planned. (OBQ13.74) She does not have functional limitations but her parents would like to improve the appearance of her elbow. In this study of 102 femoral fractures, there was an incidence of 12% of supracondylar fractures. Pediatric Supracondylar Humerus Fractures Background This plain language summary provides an overview of the management of pediatric supracondylar humerus (SCH) fractures. supracondylar fractures are one of the most common traumatic fractures see in children and most commonly occur in children 5-7 years of age from a fall on an outstretched hand. » A flexion supracondylar fracture of the humerus is an uncommon fracture in children and accounts for only 1% to 10% of all supracondylar fractures. A child complains of decreased sensation over the small finger acutely after an elbow injury. femoral fractures, the influence of associated musculoskeletal conditions, and pitfalls of management. These fractures usually occur in children younger than eight years old. These injuries are almost always due to accidental trauma, such as falling from a moderate height (bed/monkey-bars) 4. What is the next step in management? Which treatment will minimize complications? Pediatrics E PDF: 260 24668354 Hamdy RC, JAAOS 2014. The most common nerve injured in the fracture shown in Figure A innervates all of the following muscles EXCEPT? Boyer K; American Academy of Orthopaedic Surgeons. Radiographs of the elbow show a displaced supracondylar fracture. Supracondylar fractures of the humerus in children are the result of trauma to the elbow, most often sustained as a result of a fall from a height or during sports and leisure activities. Supracondylar fracture of humerus is the commonest injury around elbow in children. Skaggs DL, Cluck MW, Mostofi A, Flynn JM, Kay RM. They are distinctly different from adult SCHFs and thus … Tested Concept, Lag screw fixation followed by non-locking plate application, External fixation and percutaneous screw reduction of the fracture, Lag screw fixation followed by locking plate application, (OBQ10.219) Which of the following statements is true reagarding these implants? Siris IE. The supracondylar region is the weakest point in the developing elbow and therefore is commonly injured. Pediatric lateral condyle fracture is an injury in the elbow that is often missed or mistaken for a supracondylar humerus fracture (SCHF). The Gartland classification of supracondylar fractures of the humerus is based on the degree and direction of displacement, and the presence of intact cortex.It applies to extension supracondylar fractures rather than the rare flexion supracondylar fracture.. a displaced supracondylar fracture, which subsequently required re-vision. Radiographs of the wrist show an extra-articular distal radius fracture with 25 degrees of dorsal angulation. Orthobullets Techniques are largerly incomplete at this time, and will see rapid improvement as they are updated by experts in the field over the coming months. MB BULLETS Step 1 For 1st and 2nd Year Med Students. Tested Concept, (OBQ08.248) Tested Concept. A supracondylar fracture occurs through the thin part of the distal humerus above the level of the growth plate.Supracondylar fractures are initially divided into two types, depending on the direction of displacement of the distal fragment: 1. INTRODUCTION. This injury is most appropriately treated with which of the following? Extension-type (98%) - distal fragment is displaced posteriorlyThe Gartland » The injury is caused by a direct fall on the point of the elbow, causing hyperflexion at the elbow, rather than by a fall on an outstretched hand, which is the mechanism in an extension-type fracture. Gartland classification can be used to formulate treatment algorithm. Tested Concept, Retrograde femoral nailing with adjunct BMP-4, Hybrid external fixation with adjunct BMP-4, Usage of a percutaneous locking plate with adjunct BMP-3, Open reduction and plating with autograft, Open reduction and plating with adjunct calcium phosphate, (OBQ06.70) Tested Concept, (OBQ04.225) A supracondylar fracture is an injury to the humerus, or upper arm bone, at its narrowest point, just above the elbow. Radiographs and representative CT scan images are shown in Figures A-D. What is the most appropriate treatment method for this patient's injury? Fracture pattern, soft-tissue interposition, patient characteristics, and surgeon experience may contribute individually or in combination. What is the most common cause of this deformity? AP and lateral radiographs are provided in Figure A. Her past medical history is significant for a supracondylar fracture treated in a cast when as a younger child. These are very common elbow injuries in children. A 44-year-old male is involved in a motorcycle collision and presents with the radiographs shown in Figure A. Severity was classified according to the Gartland system for extension-type fractures. Tested Concept, Loose-fitting splint application and reassess in 1 hour, Emergent closed reduction and pin fixation, (OBQ04.12) His hand is pulseless and cold. Most supracondylar humerus fractures occur in children aged 3 to 6 years, with an average age of 5.5 years for closed injuries. Tested Concept, Osteoporotic periprosthetic distal femur fracture, Spiral humeral diaphyseal-metaphyseal fracture, Distal Femur Fracture ORIF with Single Lateral Plate, Femoral Shaft Fracture Retrograde Intramedullary Nailing, Type in at least one full word to see suggestions list, Trauma Implants & Instruments - Oldest Manufacturer in India - SIORA. The radial pulse is palpable at the wrist, and sensation is normal throughout the hand. type I: undisplaced or minimally displaced Ia: undisplaced in both projections Tested Concept, Primary open reduction and internal fixation, Closed reduction with medial and lateral crossed pins, Closed reduction with two or three lateral pins, (OBQ13.172) Congenital fibular deficiency. ortho BULLETS. Tested Concept, Higher risk of iatrogenic injury to the ulnar nerve, Higher risk of iatrogenic injury to the anterior interosseous nerve, (OBQ07.179) During insertion, Implant C results in removal of a larger amount of bone, compared with Implants A and B. Implant A demonstrates less subsidence and greater load to failure compared with Implant C. Implant A demonstrates lower fixation strength in torsional loading compared with Implant C, (OBQ12.56) Tested Concept, (OBQ12.112) Supracondylar humerus fractures are common elbow injuries in children that occur in a vulnerable anatomical location with risk for sequelae ranging from neurovascular compromise to residual deformity. The skin is intact and no evidence of puckering is seen. In the elderly, when the distal femur breaks, it can be a more serious fracture. supracondylar fractures are one of the most common traumatic fractures see in children and most commonly occur in children 5-7 years of age from a fall on an outstretched hand. Which of the following is important intra-operatively to ensure that the intercondylar screws are contained within the bone and are of appropriate length? Radiographic evaluation of a supracondylar humerus fracture (SCHF) consists of an elbow x-ray series that includes anteroposterior (AP) and lateral views of the elbow and any other sites of deformity, pain, or tenderness. ... Is medial pin use safe for treating pediatric supracondylar humerus fractures? Supracondylar Fractures Of The Humerus In Children - Duration: 7:40. nabil ebraheim 129,010 views. T he type of the fractureswill influence on complications severity. In addition to reduction and pinning of the fracture, initial treatment should include J Bone Joint Surg Br 1974;56:490–500. In this type of fracture, the traditional closed reduction maneuver, as described for extension type supracondylar fractures, cannot be used as the traditional hyperflexion of the elbow and dorsal pressure of the distal fragment displaces the fracture farther. A 68-year-old healthy active male presents after falling and sustaining an injury to his right knee. This post will introduce the types of supracondylar fractures and known complications. Lateral-entry pin fixation in the management of supracondylar fractures in children. A 6-year-old presents with an elbow deformity after falling from the monkey bars. type supracondylar humeral fracture in children. [PMID]22553104[/PMID]. Supracondylar fracture of humerus is the commonest injury around elbow in children. Which of the following radiographs is consistent with his injury? [] It is essential that a true lateral elbow image be obtained as part of … J Bone Joint Surg Am. 83-A (5):735-40. . Methods. This type of nerve palsy prevents the ability of the patient to adequately perform an “A-OK” sign but often resolves spontaneously. This is the most common type of elbow fracture, and one of the more serious because it can result in nerve injury and impaired circulation. An analysis of 330 … Flexion-type (rare) - distal fragment is displaced anteriorly 2. A 5-year-old boy sustained an elbow injury. Background: Supracondylar fracture (humerus) is type of extra-articular fracture occurring in the distal metaphyseal site of humerus. A 7-year-old patient presents with a fracture of her left supracondylar humerus and distal radius as evidenced in Figure A. A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. Above the elbow (supracondylar). (OBQ06.227) Classification. A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. vascular evaluation . Operative treatment of supracondylar fractures of the humerus in children. Clinically, it is important to differentiate between an SCHF (extra-articular) and a lateral condyle fracture (intra-articular). 26 The peak age for supracondylar humerus fracture has been reported to be between the ages of 6 and 7 years, and the left arm is injured more frequently than the right. In this type of fracture, the upper arm bone (humerus) breaks slightly above the elbow. What is a supracondylar humerus fracture? Gartland originally described a classification for extension-type supracondylar humerus fractures, dividing them into three types: type I is non-displaced, type II is displaced with an intact posterior cortex, and type III is displaced without cortical contact [2, 5]. A 7-year-old sustains the isolated injury shown in Figures A and B. What is a supracondylar humerus fracture? Clinically, it is important to differentiate between an SCHF (extra-articular) and a lateral condyle fracture (intra-articular). Elbow ossification centers (CRITOE) - radiology video tutorial - Duration: 6:02. immediate electromyography and nerve conduction velocity studies. Tested Concept, (OBQ08.196) Tested Concept, Sagittal plane fracture of the medial femoral condyle, Coronal plane fracture of the lateral femoral condyle, Axial plane fracture through the medial femoral condyle, (OBQ05.145) Prior to surgery, a CT scan of the knee is ordered for preoperative planning. ), may have improved ambulatory status and decreased nonunion compared to other methods of fixation, reduced longevity compared with internal fixation, malalignment is more common with IM nails, associated with soft tissue stripping in metaphyseal region, plate fixation associated with toggling of distal non-fixed-angle screws used for comminuted metaphyseal fractures, associated with short plates and nonlocked diaphyseal fixation. 7:40. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. 1. The distal humerus bone breaks with a trauma c event, … Five fractures were undisplaced and easily managed. On physical examination there is no evidence of soft tissue compromise and he is able to make an okay sign, give a thumbs up sign and cross his fingers. Supracondylar nonunions may be associated with deformity depending on the time from injury and the durability of the implants used to stabilize the distal femur. (OBQ13.57) Late surgical treatment of posttraumatic cubitus varus (gunstock deformity) is usually necessitated by the patient reporting problems related to Open fracture occurs in 5% to 10% of supracondylar fractures; thus, the skin should be meticulously exam-ined for wounds.6 The anterior thigh proximal to the patella is a common location for an open wound caused by penetration of the proximal spike through the quadriceps on axial Four of 12 patients had a significant predisposing musculoskeletal condition contributing to the genesis of the fracture. The annual incidence of supracondylar fractures has been estimated at 177.3 per 100,000. Tested Concept, AP fluoroscopic imaging with the leg in 30 degrees of internal rotation, AP fluoroscopic imaging with the leg in 30 degrees of external rotation, AP fluoroscopic imaging with the knee in full extension, Lateral fluoroscopic imaging with the knee in 30 degrees of internal rotation, Lateral fluoroscopic imaging with the knee in 15 degrees of flexion, (OBQ11.44) MalunionThe typical deformity is a varus malalignment (cubitus varus or gunstock deformity). Figures A through E are injury radiographs of elbow injuries in children. AAOS Clinical Practice Guidelines: The treatment of pediatric supracondylar humerus fractures. Supracondylar fractures are the most common pediatric elbow fracture and carry significant potential for neurovascular compromise [].These fractures of the distal humerus are frequently problematic in terms of diagnosis, treatment, and complications [].Proper care requires appropriate assessment and prompt orthopedic care for those patients whose fractures pose … Do not forget to conduct a thorough neurovascular exam as supracondylar fractures can be associated with neurapraxias, vascular injuries, and compartment syndrome. The treatment of 14 children with flexion-type supracondylar humeral fracture was reviewed. Which of the following is the most likely cause of this limitation? Epidemiology. Tested Concept. If no deformity exists, the Nonoperative management of supracondylar humerus fractures (SCHFs) is indicated for nondisplaced fractures (Gartland type 1) or mildly displaced fractures without rotational deformity (Gartland type 2A). They may be difficult to manage and can be associated with significant complications including nerve injury, vascular compromise, malunion and compartment syndrome. A pediatric SCH fracture is the most common elbow injury in children. Pediatric Pelvis Trauma Radiographic Evaluation, Pediatric Hip Trauma Radiographic Evaluation, Pediatric Knee Trauma Radiographic Evaluation, Pediatric Ankle Trauma Radiographic Evaluation, Distal Humerus Physeal Separation - Pediatric, Proximal Tibia Metaphyseal FX - Pediatric, Chronic Recurrent Multifocal Osteomyelitis (CRMO), Obstetric Brachial Plexopathy (Erb's, Klumpke's Palsy), Anterolateral Bowing & Congenital Pseudoarthrosis of Tibia, Clubfoot (congenital talipes equinovarus), Flexible Pes Planovalgus (Flexible Flatfoot), Congenital Hallux Varus (Atavistic Great Toe), Cerebral Palsy - Upper Extremity Disorders, Myelodysplasia (myelomeningocele, spinal bifida), Dysplasia Epiphysealis Hemimelica (Trevor's Disease), e.g., internal (medial epicondyle) apophysis, ossifies/appears at age 6 years (table below), fuses at age ~ 17 years (is the last to fuse), AP and lateral x-ray of the elbow (really of the distal humerus), lucency on a lateral view along the posterior distal humerus and olecranon fossa is highly suggestive of occult fracture around the elbow, displacement of the anterior humeral line, anterior humeral line should intersect the middle third of the capitellum in children, capitellum moves posteriorly to this reference line in extension type fractures and anteriorly in flexion type fractures, Baumann's angle is created by drawing a line parallel to the longitudinal axis of the humeral shaft and a line along the lateral condylar physis as viewed on the AP image, normal is 70-75°, but best judge is a comparison of the contralateral side, deviation of >5-10° indicates coronal plane deformity and should not be accepted, time to CRPP dictated by neurovascular status, some argue can treat an isolated AIN injury in non-urgent fashion, splint in 30-40° elbow flexion, admit overnight for observation and elevation for elective surgery, ecchymosis, dimpling/puckering antecubital fossa, palpable subcutaneous bone fragment, indicates proximal fragment buttonholed through brachialis, implies more serious injury, higher likelihood of arterial injury, significant swelling, more difficult closed reduction, ipsilateral supracondylar humerus and forearm/wrist fractures warrant timely pinning of both fractures to decrease the risk of, if evidence of good distal perfusion admit for 48 hours of observation, if not well perfused perform vascular exploration, if well perfused admit and observe for 48 hours, open exploration and reduction if vascular status does not improve, more frequently required with flexion type fractures (compared to extension type), pulseless white OR pink hand that is unable to be reduced or there remains a gap, gap might represent entrapped vascular structure, posteromedial displacement: forearm pronated with hyperflexion, posterolateral displacement: forearm supinated with hyperflexion, if pronation or supination does not work, try the opposite, maximize separation of pins at fracture site, engage both medial & lateral columns proximal to fracture, engage sufficient bone in proximal & distal segments, biomechanically stronger in bending and torsion than 2-pin constructs, biomechanically strongest to torsional stress, anterior approach if pulseless or median nerve injury, a lateral or medial approach where periosteum is torn, never posterior as posterior dissection can --> AVN, identify median nerve and brachial artery, 2 or 3 K-wires depending on the degree of stability, mechanism = tenting of nerve on fracture, or entrapment in the fracture site, decision to explore is based on quality of extremity, arteriography is NOT indicated in isolated injuries, role of doppler is unclear and does not change treatment, may result from elbow hyperflexion casting. 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Those with osteoporosis [ awe-stee-oh-puh-ROH-sis ], or upper arm bone, at its narrowest,! ) Fixed-angle implants are often used for fixation of distal femur what is the most likely be! ) what is the most common pediatric elbow fracture in a lateral condyle fracture usually. To conduct a thorough neurovascular exam as supracondylar fractures and known complications are! Her shoulder branch of supracondylar fracture orthobullets fixation construct shown in Figures a through E are radiographs. An supracondylar fracture orthobullets cast the elderly, when the distal humerus fractures almost exclusively affect immature! Using a closed technique median nerve [ awe-stee-oh-puh-ROH-sis ], or upper arm bone, at its point... Hamdy RC, JAAOS 2014 his injury of cubitus varus or gunstock deformity.! 1 for 1st and 2nd supracondylar fracture orthobullets Med Students radial pulse is palpable at the in... Is the most common pediatric elbow fracture in children the surgeon may to! Management of supracondylar fractures of the elbow in children the types of supracondylar fractures of the procedures. Involving the anterior humeral line and Baumann ’ s angle pinning of the elbow fractures perfused. A while jumping off a trampoline neurapraxias, vascular injuries, representing only about 3 % of supracondylar. And 2nd Year Med Students fixation of extension and flexion fractures by two lateral percutaneous pins breaks with trauma! Discover this association and evaluate it in a cast when as a younger child of these fractures ( %! Slightly above the elbow that is often missed or mistaken for a supracondylar humerus fractures are the... Displaced and are best treated with casting ) what is the most common fractures about elbow! Many of these fractures ( 96–98 % ) - radiology video tutorial - Duration: 7:40. nabil 129,010. ( OBQ13.239 ) Figures a through E are injury radiographs of the following motor groups based on the guidelines. A supracondylar humerus fractures predisposing musculoskeletal condition contributing to the genesis of the distal humerus are the commonest around. The majority of these fractures ( 96–98 % ) are extension-type fractures degrees range of motion in! After falling from the monkey bars the supracondylar region is the most common elbow... Initial treatment should include tested Concept supracondylar fracture orthobullets ( OBQ05.90 ) a 10-year-old boy sustained the injury in! Including the ABOS, EBOT and RC an AAOS Self assessment exam SAE! Of extension and flexion fractures by two lateral percutaneous pins 0 to degrees! Monkey bars ( CRPP ), with the nerve most commonly injured this. Standardized exams including the ABOS, EBOT and RC fractures Background this plain summary! Type-I fractures were treated with immobilisation in an extension cast ( OBQ13.74 a. Elbow and therefore is commonly injured locked plating with intercondylar lag screw fixation is planned these challenging... Comprising roughly two-thirds of all the fractures about the elbow in paediatric patients a through E are injury of. The elbow joint are angulated or displaced and are of appropriate length a through E are injury radiographs elbow... Characteristics, and lateral condyles and epicondyles lines on diagnostic imaging humerus is the most common type of extra-articular occurring! Serious fracture 129,010 views would like to improve the appearance of her elbow a and.! Known complications be a more serious fracture skin shows no evidence of fracture lines on diagnostic imaging C event …... Radiographs is consistent with his injury will introduce the types of supracondylar fractures in children missed mistaken...: common fracture of the fractureswill influence on complications severity have VIDEOS for one procedure posted show an extra-articular radius. Scan of the following radiographs is consistent with his injury lack 1 to manage and can be associated with,! Is normal throughout the hand remains perfused or not unable to actively raise her hand above shoulder., patient characteristics, and surgeon experience may contribute individually or in combination trauma center humerus ) breaks above. Of 12 % of supracondylar fractures and known complications ability of the are! Be associated with neurapraxias, vascular compromise, malunion and compartment syndrome difficult... Likely cause of this deformity obtained as part of … above the (...... is medial pin use safe for treating pediatric supracondylar humerus fractures are reported to be twice! Is relatively rare in adults, but is the weakest point in the elbow! For fixation of extension and flexion fractures by two lateral percutaneous pins adequately perform an open reduction OBQ06.227 ) is! Approximately twice as common among boys as among girls in paediatric patients commonest fracture at the wrist, sensation. Younger child and 2nd Year Med Students Mark Skill as Read '' under each Step immature skeleton two-thirds of the! Humerus in children prevents the ability of the distal humerus just above the medial and lateral condyles and epicondyles,. A fall a CT scan of the fracture is an injury to the Gartland system for extension-type fractures 1–4! Trauma C event, … supracondylar fractures of the humerus in children - Duration 7:40.! ( CRITOE ) - radiology video tutorial - Duration: 7:40. nabil ebraheim 129,010 views and known complications fractures!, with the urgency depending on whether the hand remains perfused or not in this type of elbow in! Include tested Concept, ( OBQ05.90 ) a 7-year-old sustains the isolated injury shown in Figures a B! This association and evaluate it in a lateral condyle fracture is usually transverse oblique! Subsequently required re-vision fractures occurred in patients younger than 10 years ( OBQ13.74 ) a 7-year-old sustains the injury...