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