Treatment of flexiontype supracondylar humeral fracture. 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. 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. Supracondylar fractures of the humerus represent a significant burden of injuries in children, accounting for 1217% of all paediatric fractures 2. 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. But an occluded or tethered artery may recover with adequate fracture reduction. Supracondylar fractures are very common in children and account for about 60% of all paediatric elbow fractures. Management of gartlands type iii supracondylar fractures of the humerus in children. Objective the aim of this study was to compare three common orthopaedic procedures in the treatment of displaced extension type. Your childs humerus is fractured broken near the elbow area, just above the joint. These fractures are the result of trauma to the elbow, most often from a fall from height monkey bars are. Supracondylar fractures of the humerus in children are either flexion or extension in type. Simple supracondylar fractures are typically seen in younger children, and are uncommon in adults.
After the cast is removed when the backslab is removed, the skin may be dry and itchy. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. Supracondylar fractures of the humerus were treated in 50 children over a sixyear period. The backslab and sling should be placed under figure 2. We use your linkedin profile and activity data to personalize ads and to show you more relevant ads. Ultrasound diagnosis of supracondylar fractures in children.
Jan 02, 2017 vascular injury radial pulse is absent on initial presentation in 7% to 12% of patients with supracondylar fractures. In the printed or pdf version of this article, author affiliations can be found at the bottom of the. This is called a supracondylar supra con dy ler humerus fracture. Supracondylar fracture of the humerus is a common fracture in children.
Extension injuries account for 95% of supracondylar fractures. Of orthopedics mmmc slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. We undertook a retrospective study of 39 children with displaced supracondylar fractures treated by delayed closed reduction with fluoroscopic guidance. Incidence of impaired circulation after an adequate fracture reduction is less than 0.
Children typically are between ages 5 and 7 years, and boys and girls are affected equally. Supracondylar fracture pediatric pediatrics orthobullets. Material and methods followup examinations were performed in 151 patients who had sustained supra condylar fracture of the humerus during the period when they were children 19471958. 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 are they. Supracondylar humerus fracture what is a supracondylar fracture. Around 85% of elbow fractures in children occur in the distal humerus, and of these, 55 to 75% are supracondylar fractures, accounting for. The objective of our study was to evaluate the safety and accuracy of ultrasound us compared to standard radiographs in diagnosing supracondylar fractures scfs of the humerus in children. Fracture, supracondylar humerus childrens hospital colorado. Between 40 and 60 per cent of all fractures in the elbow region are of this type blount et al. Supracondylar fractures of the humerus are the most common fractures in children under the age of 7 1 and the most common paediatric fracture requiring surgery 2. Neurovascular complications after supracondylar humerus.
A supracondylar fracture is an injury to the humerus, or upper arm bone, at its narrowest point, just above the elbow. These fractures are classified using the modified gartland. Of the upper limbs in children, the elbow is the second most common site of occurrence of fractures, surpassed only by forearm fractures. Supracondylar humeral fracture, a common injury in the pediatric population, usually is seen in children in the first decade of life. Supracondylar humeral fractures, often simply referred to as supracondylar fractures, are a classic pediatric injury which require vigilance as imaging findings can be subtle. Around 85% of elbow fractures in children occur in the distal humerus, and of these, 55 to 75% are supracondylar fractures, accounting for 3% of all fractures in children1, 2, 3, 4. Supracondylar fractures of the distal humerus are the most common fractures about the elbow seen in children. Management of supracondylar fractures of the humerus in.
This normally takes approximately six weeks to heal. Guideline on the treatment of pediatric supracondylar humerus fractures 2011. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. Supracondylar and lateral condyle fractures of the humerus in. Management of supracondylar fractures of the humerus in children. When this occurs, the condition is commonly known as a supracondylar fracture. Pdf supracondylar humerus fractures in children wendy.
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. Supracondylar humerus fractures are the most common elbow fracture in children and have the highest complication rate for elbow fractures in this age group. To investigate the time required for elbow range of motion rom recovery after supracondylar and lateral condylar fractures in children and to analyze the relationship between the rom recovery and the related factors. Supracondylar humeral fractures are the most common elbow fractures in children and represent 3 % of all paediatric fractures. Supracondylar fractures in children are common,1 accounting for 65% of all elbow fractures in children. Studies have shown that these fractures occur commonly in children aged between 510 years and up to. The specific etiology of supracondylar humerus fractures in children is not well known. It has been estimated that they account for approximately 65% of all fractures and dislocations in children. In this type of fracture, the upper arm bone humerus breaks slightly above the elbow. The ulnar nerve with its posterior location is uncommonly involved with a typical extensiontype supracondylar fracture. Pediatric supracondylar humerus fractures journal of hand surgery. It is the most common type of elbow fracture and happens most often to children younger than 8 years old. Mar 08, 2012 this feature is not available right now. Stans, in morreys the elbow and its disorders fifth edition, 2018.
Appropriate use criteria auc provide treatment recommendations on a patientspecific level using evidence from aaos clinical practice guidelines, along with clinician expertise and experience. Multidisciplinary clinician work groups and aaos staff work together to synthesize published research. The nondominant hand, usually the left hand, is more commonly injured. A randomized control design rcd was conducted to compare the two groups ot group and control group and several. Bathe with warm water and soap, and apply a gentle moisturiser. Supracondylar fracture fractured humerus physioadvisor. The most common fractures of the distal humerus in children are supracondylar hu merus fractures, lateral condyle fractures, medial epicondyle. Supracondylar humerus fractures pin fixation many children have anterior subluxation of the ulnar nerve with hyperflexion of the elbow some recommend place two lateral pins, assess fracture stability if unstable then extend elbow to take tension off ulnar nerve and place medial pin eberl. Supracondylar humerus fracture nationwide childrens hospital. Pdf humeral supracondylar fractures are the second most common fractures seen in children and young teenagers 16. Neurovascular injuries in type iii humeral supracondylar fra. The mechanism leading to this fracture is most often a fall on the hand with fully extended elbow. Supracondylar fractures of the humerus in children longdom.
Boast supracondylar fractures in the humerus in children. Children with a displaced supracondylar fracture of the distal humerus. 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 the fortunately rare incidence of volkmanns ischaemic contracture, an appropriate. The recovery of elbow range of motion after treatment of. Inrareinstances,researchershaveevaluatedagesegregated subsets of the supracondylar humeral fracture population. A total of 106 children aged between 1 and years with clinically suspected scf of the humerus were primarily examined by us followed by standard twoplane radiographs of the elbow. Supracondylar humerus fractures are the most common elbow fracture in children and account for 3% to 18% of all pediatric fractures. They are considered serious injuries because of the risk of neurovascular injury or malunion. Your child has sustained a supracondylar fracture to their elbow this means that they have sustained a fracture just above their elbow joint. This fracture commonly occurs after a fall on an outstretched arm.
Prognostic factors for the outcome of supracondylar humeral. Displaced supracondylar humerus fractures in children. Nonphyseal supracondylar fractures of the femur are considered to be uncommon in children and have received little attention in the literature. Supracondylar humeral fractures account for 60 percent of fractures near the elbow among children. Documentation of neurovascular status in supracondylar. They mostly occur between the ages of 5 and 10 with the peak incidence occurring between 58 years of age after this, dislocations become more frequent9.
Humeral supracondylar fracture an overview sciencedirect. The radial nerve lies posterolateral to the usual location of supracondylar fractures and, thus, is less commonly involved see fig. They may be difficult to manage and can be associated with significant complications including nerve injury, vascular compromise, malunion and compartment syndrome. In this study we included 97 patients aged 0 to 18 years with displaced. The incidence of neural injury associated with these fractures has been reported to be between 6% and 16% 47,11,1622,2426 except for a recently published series in which neural injury was documented in 42. A supracondylar fracture is more common in children than in adults. Fractures that remain stable after reduction can be. Clinical practice guideline on the treatment of pediatric supracondylar humerus fractures.
All supracondylar humerus fractures treated at children s hospital and health center, san diego chsd over. To assess the results of treatment for flexiontype supracondylar humeral fracture in children. Severity was classified according to the gartland system for extensiontype fractures. Supracondylar humerus fractures are the most common type of elbow fracture in children. Dec, 2011 supracondylar fractures in children dept. The fracture occurs just above the elbow at the area of the distal humerus that is relatively narrow and weak in the immature skeleton. The usual mechanism is a fall onto the outstretched hand with hyperextension at the elbow. Introduction closed reduction and percutaneous pinning are the most widely used treatment options for displaced supracondylar humerus fractures in children, but there is still no consensus concerning the most preferred technique in injuries of the extension type. Among these fractures supracondylar humerus fractures are one of the. Their mean age at the time of fracture was 7 years range 2 years. These fractures usually occur in children younger than eight years old. Children aged seven years or older who sustain supracondylar humeral fractures tend to get more comminuted fractures. Treatment of supracondylar humerus fractures in children, according to gartland classification emilis cekanauskas, ramune degliute, romas jonas kalesinskas1 clinic of children surgery, 1clinic of orthopedics and traumatology, kaunas university of medicine hospital, lithuania key words.
Methods total of 93 consecutive patients 66 boys and 27 girls referred to our hospital with gartland type ii or iii extension supracondylar humeral fractures were prospectively included in the study over a sixyear period. These are the two guidelines authors found useful in the diagnosis and treatment of supracondylar humerus fractures. Supracondylar fractures of the humerus in children. Clinical practice guidelines cpg provide evidencebased. Pediatric supracondylar humerus fractures guidelines. Supracondylar fractures are the most common type of upper arm injury in children. One from the royal childrens hospital in melbourne australia, and one published on the american academy of orthopaedic surgeons guidelines. A supracondylar humerus sch fracture is the most common type of elbow fracture in children. Of the total number of 176 patients, 36 were excluded from our study, because there was neither fracture dislocation nor reduction. Raise the arm on a pillow when sitting or lying down loose fitting clothing, not through the sleeve. Appropriate use criteria of pediatric supracondylar humerus fractures. Supracondylar humerus fracture patient safety checklist. The most common cause is a fall onto an outstretched hand with the elbow in extension, resulting in an extensiontype fracture 9799 % of cases.
When these forces are traumatic and exceed the bones tolerance, a break in the supracondylar region of the humerus may result. The metaphyseal flare of the distal humerus connects the diaphysis of the humeral shaft to the epiphysis. To detect the influence of the type of osteosynthesis, the timing of surgery, and the experience of the surgeon on the outcome of supracondylar humeral fractures in children. One from the royal children s hospital in melbourne australia, and one published on the american academy of orthopaedic surgeons guidelines. Supracondylar fractures of the humerus are one of the most common fractures of childhood. Supracondylar fracture of the humerus is the second most common fracture in children 16. Supracondylar humeral fractures are the second most common fracture type in children. Transolecranon and lateral kirschner wire fixation for. Large studies have shown that supracondylar fractures occur with nearly. Multiple studies have shown their peak incidence to be among 5 to 6yearolds, with an age range that reaches from 1 to 14 years712. Treatment of supracondylar humerus fractures in children.
Supracondylar humerus fractures are a common injury in children and account for approximately 15% of all pediatric fractures. During this healing period, it is important that your child follows the rehabilitation plan on the following page. Supracondylar fractures comprise 6575% of all elbow fractures in children 9. 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. A documented assessment of the limb, performed on presentation. Supracondylar humeral fracture radiology reference article.
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. Supracondylar fractures of the humerus in children british. Displaced supracondylar humeral fractures in children. Detail treatment guidelines for pediatric supracondylar fractures. Pediatric supracondylar fractures and pediatric physeal elbow. Aug 27, 2018 these are the two guidelines authors found useful in the diagnosis and treatment of supracondylar humerus fractures. Pdf supracondylar fracture of the humerus in children. Typei fractures were treated with immobilisation in an extension cast. 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 elbow fracture undisplaced royal childrens.
Supracondylar fractures are the most common fracture of the elbow in children. Pdf upper extremity fractures account for up to 90% of pediatric fractures. Supracondylar fractures are the most common elbow fracture in children, especially in the first decade of life. Complications of supracondylar fractures of the elbow. It occurs at the bottom part of the humerus bone figures 1a and 1b.
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