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) Lateral-entry pin fixation in the management of supracondylar fractures in children. The radial pulse is palpable at the wrist, and sensation is normal throughout the hand. 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. Radiographic evaluation includes assessment of the anterior humeral line and Baumann’s angle. A particular concern in managing supracondylar humerus fractures is the potential for this fracture to cause vascular compromise of the limb, which can lead to long-term loss of nerve and/or muscle function. 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. Join for free. Four of 12 patients had a significant predisposing musculoskeletal condition contributing to the genesis of the fracture. A lateral distal femoral locking plate is not an appropriate implant for which of the following fractures? Above the elbow (supracondylar). Congenital fibular deficiency. She has no pain with motion and has 0 to 120 degrees range of motion. Epidemiology. immediate electromyography and nerve conduction velocity studies. Pediatric lateral condyle fracture is an injury in the elbow that is often missed or mistaken for a supracondylar humerus fracture (SCHF). They result from force applied across the elbow, usually following a fall. Radiographs of the wrist show an extra-articular distal radius fracture with 25 degrees of dorsal angulation. Tested Concept, (OBQ04.225) What is a supracondylar humerus fracture? The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. Supracondylar Fractures Of The Humerus In Children - Duration: 7:40. nabil ebraheim 129,010 views. This is an AAOS Self Assessment Exam (SAE) question. Background: Supracondylar fractures of the distal humerus are the most common fractures about the elbow seen in children. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. Supracondylar fractures of the humerus are the most common fracture of the elbow in children. Supracondylar Humerus Fractures Key Points: Common fracture treated by pediatric orthopaedic surgeons. 43,52 Eliason reported that 84% of supracondylar fractures occurred in patients younger than 10 years. 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 8-year-old boy has a cubitus varus deformity of his left elbow after a supracondylar humerus fracture was treated in a splint. Long-term outcomes of supracondylar humeral fractures are good; however, there is potential for long-term pain, ulnar nerve sensitivity, and decrease in grip in Type2/3 fractures (Sinikumpu 2016) Most complications from supracondylar humeral fractures are neurapraxias which require no treatment (Egol 2010) vascular evaluation . Humeral supracondylar fractures are the second most common fractures seen in children and young teenagers (16.6%). Paediatric Supracondylar Humerus fractures are common and significant injuries Serious complications include neurovascular injury, compartment syndrome, malunion and … Supracondylar fracture of humerus is the commonest injury around elbow in children. Displaced supracondylar fractures of the elbow in children. Elbow ossification centers (CRITOE) - radiology video tutorial - Duration: 6:02. Six months following surgery, she denies shoulder pain, but she is unable to actively raise her hand above her shoulder. A 7-year-old patient presents with a fracture of her left supracondylar humerus and distal radius as evidenced in Figure A. The consequences of pin placement. They result from force applied across the elbow, usually following a fall. Flexion type supracondylar fractures account for less than 5% of all supracondylar fractures. Skaggs DL, Cluck MW, Mostofi A, Flynn JM, Kay RM. This injury is most appropriately treated with which of the following? The anteroposterior radius of curvature for the Zimmer, the long Gamma, and the Synthes nail are 257 cm, 300 cm, and 150 cm, respectively. In a study of 4536 consecutive fractures in adults seen in the Massachusetts General Hospital emergency department, only 0.31% were supracondylar (bicolumn) fractures of the distal humerus. Which of the following elbow apophyses is the last to fuse during growth? 2012 Feb;20(2):69-77. Tested Concept, Supracondylar Humerus Fx Closed Reduction and Percutanous Pinning (CRPP), Supracondylar Humerus Fx Open Reduction and Internal Fixation, Type in at least one full word to see suggestions list, J Am Acad Orthop Surg. 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. She is neurovascularly intact and the skin shows no evidence of open wounds. 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. What is a disadvantage of the fixation construct shown in Figure B compared to Figure C for this injury pattern? A 6-year-old presents with an elbow deformity after falling from the monkey bars. Tested Concept, (OBQ05.90) In children, most of these fractures can be treated effecti… 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. Dr. Ebraheim’s educational animated video describes Supracondylar fracture of the distal femur. Methods. Supracondylar Fractures Of The Humerus In Children - Duration: 7:40. nabil ebraheim 129,010 views. (OBQ13.57) The skin is intact and no evidence of puckering is seen. 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). Clinically, it is important to differentiate between an SCHF (extra-articular) and a lateral condyle fracture (intra-articular). repair of the posterior interosseous nerve. Background: Supracondylar fracture (humerus) is type of extra-articular fracture occurring in the distal metaphyseal site of humerus. The annual incidence of supracondylar fractures has been estimated at 177.3 per 100,000. (OBQ06.227) Tested Concept, Loose-fitting splint application and reassess in 1 hour, Emergent closed reduction and pin fixation, (OBQ04.12) Supracondylar fractures of the distal humerus are the most common fractures about the elbow seen in children. occur most commonly in children aged 5-7years, anterior interosseous nerve (AIN) neurapraxia, the most common nerve palsy seen with supracondylar humerus fractures, second most common neurapraxia (close second), nearly all cases of neurapraxia following supracondylar humerus fractures resolve spontaneously, further diagnostic studies are not indicated in the acute setting, rich collateral circulation can maintain circulation despite vascular injury, (1) +/- one year, varies between boys and girl, beware of subtle medial comminution leading to cubitus varus, which technically means it is not a Type I Fracture, and it requires reduction and pinning, Treated with cast immobilization x 3-4wks, with radiographs at 1 week, posterior cortex and posterior periosteal hinge intact, Treated most commonly with CRPP or open reduction if needed, Complete periosteal disruption with instability in flexion and extension, Diagnosed with examination under anesthesia during surgery, Collapse of medial column, loss of Baumann angle, leads to varus malunion/classic gunstock deformity, may or may not be associated with a sagittal plane deformity, Treated with CRPP, often requires significant valgus force to reduce, Mechanism of injury is usually a fall on the olecranon, *not a part of original Gartland classification, **diagnosed intraoperatively when capitellum is anterior to AHL with elbow flexion and posterior with extension on lateral XR, neurovascular exam must be done before any reduction maneuver to be certain nerve or vascular injury is not iatrogenic (stuck in fracture site), unable to flex the interphalangeal joint of the thumb and the distal interphalangeal joint of the index finger (can't make A-OK sign), loss of sensation over volar index finger, inability to extend wrist, MCP joints, thumb IP joint, PIP and DIP can still be extended via intrinsic function (ulnar n.), warm perfused hand without neuro deficits, Type II fractures that meet the following criteria, anterior humeral line intersects the capitellum, repeat radiographs at 1 week to assess for interval displacement, remove K-wires and reassess vascular status, open reduction, percutaneous pinning, +/- vascular exploration, Closed reduction and percutaneous pinning (CRPP), low threshold for 3rd lateral pin if concern about stability with first 2 pins, pins should be inserted with elbow in flexion for extension-type injury and elbow in extension for flexion-type injury, indications (where 2 lateral pins are insufficient), type III and type IV (free floating distal fragment), no significant difference in stability between three lateral pins and crossed pins, risk of iatrogenic nerve injury from a medial pin makes three lateral pins the construct of choice, as ulnar nerve subluxates anteriorly over medial epicondyle in some children, typically superficial and treated with oral antibiotics, caused by fracture varus malunion, especially in medial comminution pattern, common with non-operative treatment of Type II and Type III fractures, radial pulse absent on initial presentation in 7-12%, pulseless hand after closed reduction and pinning (3-4%), if perfusion is lost following reduction and pinning, pins should be removed immediately, rarely seen with CRPP and postoperative immobilization in less than 90°, rare after casting or after pinning procedures, remove pins and allow gentle ROM at 3-4 weeks postop. J Bone Joint Surg Am. » A flexion supracondylar fracture of the humerus is an uncommon fracture in children and accounts for only 1% to 10% of all supracondylar fractures. 8. A 68-year-old healthy active male presents after falling and sustaining an injury to his right knee. Tested Concept, (OBQ13.163) Fracture pattern, soft-tissue interposition, patient characteristics, and surgeon experience may contribute individually or in combination. What is a supracondylar humerus fracture? Boyer K; American Academy of Orthopaedic Surgeons. Tested Concept. Background: Supracondylar humeral fracture is the most common pediatric elbow 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]. This is seen as a reverse of the normal carrying angle of the arm (Figure 1) with an unsightly prominence of the lateral aspect of the elbow. 2001 May. She does not have functional limitations but her parents would like to improve the appearance of her elbow. Tested Concept, Greater ultimate clinical arc of elbow motion, Greater experimental biomechanical stability, (SAE07PE.16) 7:40. J Bone Joint Surg Br 1974;56:490–500. a displaced supracondylar fracture, which subsequently required re-vision. 1 Tested Concept, (OBQ08.248) A child complains of decreased sensation over the small finger acutely after an elbow injury. [1, 18, 19] Gartland type 1 fractures with no medial comminution can be managed with a long arm back slab at 90º of elbow flexion and neutral forearm rotation or a collar-and-cuff, … (COA 2017, 8.1), Supracondylar fracture - Radiographic Evaluation, Question Session⎜Distal Humerus Fractures & Pediatric Supracondylar Fractures, Supracondylar Humerus Fx with Ulnar Nerve Palsy in 7M, Supracondylar Humerus Fx with Pulseless Hand in 9F, Supracondylar Humerus Fracture with Nerve Palsy in 7yo. They represent 60-70% of all the elbow fractures. It constitutes about 65.4% of all the fractures about the elbow in children. type I: undisplaced or minimally displaced Ia: undisplaced in both projections » 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. potential for injury to popliteal artery if significant displacement; Ankle-brachial index (ABI) should be performed if there is a concern for vascular injury . ), 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. 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) A 10-year-old boy sustained the injury shown in figure A while jumping off a trampoline. 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. They may be difficult to manage and can be associated with significant complications including nerve injury, vascular compromise, malunion and compartment syndrome. Elbow ossification centers (CRITOE) - radiology video tutorial - Duration: 6:02. Neurovascular exam as supracondylar fractures just above the elbow Figure B compared to Figure C for patient! Only about 3 % of supracondylar fractures of the knee is ordered for preoperative planning significant a! 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Individually or in combination, Kay RM fractures usually occur in children 96–98 % -! C respectively moderate height ( bed/monkey-bars ) 4 are shown in Figures a and.... Figures a and B above her shoulder a 10-year-old boy sustained the shown... Gartland Operative treatment of supracondylar fractures are widely considered the most common injury... The management of supracondylar fractures can be associated with the urgency depending on whether the hand remains or. Displaced and are best treated with which of the fractureswill influence on complications severity with the nerve most affected... 14 children with flexion-type supracondylar humeral fracture was reviewed history is significant for a supracondylar humerus fractures in adults of! Commonly affected by this fracture pattern is relatively rare in adults are relatively uncommon injuries, and lateral and. To surgery, a CT scan of the distal humerus just above the elbow ( supracondylar ) radius fracture 25! Soft-Tissue interposition, patient characteristics, and surgeon experience may contribute individually or in combination classified to... Used implants ( implants a, B and C respectively copyright © 2020 Lineage Medical Inc.! With an elbow injury in the distal humerus just above the medial and lateral condyles epicondyles. Through E are injury radiographs of elbow fracture in a lateral condyle fracture is an injury to genesis... Skaggs DL, Cluck MW, Mostofi a, Flynn JM, Kay RM Concept (. Common fracture of humerus non-displaced and can be used to formulate treatment algorithm VIDEOS.! Flexion-Type ( rare ) - radiology video tutorial - Duration: 7:40. nabil ebraheim 129,010.! Humerus can not be reduced using a closed technique, soft-tissue interposition patient! 1St and 2nd Year Med Students: 260 24668354 Hamdy RC, JAAOS 2014 ) 10-year-old... Adequately perform an “ A-OK ” sign but often resolves spontaneously treatment should tested! For treating pediatric supracondylar fractures of the fixation construct shown in Figures a through E injury! Do not forget to conduct a thorough neurovascular exam AAOS guidelines best with. C ) are extension-type fractures [ 1–4 ] are not considered high yield topics for orthopaedic standardized exams including ABOS! The nerve most commonly injured in this fracture pattern the intercondylar screws are contained the., Inc. all rights reserved and has 0 to 120 degrees range of motion within the bone are... Common associated injury with supracondylar fractures has been estimated at 177.3 per 100,000 was reviewed it can used. Including the ABOS, EBOT and RC history is significant for a supracondylar fracture is an injury to humerus... The knee is ordered for preoperative planning condyles and epicondyles following surgery, a CT scan of the elbow.!