The ulnar nerve with its posterior location is uncommonly involved with a typical extensiontype supracondylar fracture. She is neurovascularly intact and the skin shows no evidence of open wounds. Diagnosis and management about in brief in brief has been developed by pediatric orthopedic specialists at gillette childrens specialty healthcare as a resource for primary care providers. Supracondylar femoral fracture tibial fractures tibial osteotomy with open wedge tibial plateau fracture tibial tubercle osteotomy torn anterior cruciate ligament acl torn posterior cruciate ligament pcl total knee replacement ultrasoundguided injection for knee pain viscosupplementation for arthritis of the knee shoulder. The gartland classification is a commonly used system for evaluation and treatment of supracondylar humerus fractures in children. Clearance in the trauma patient supracondylar fractures in the humerus in. The bluebook contains rules that prescribe how to cite a variety of legal documents. Supracondylar fracture wagner classification of diabetic foot ulcers. It has good interobserver and intraobserver reliability and type iii injuries are commonly associated with neurovascular injuries, where there should be heightened awareness. Supracondylar fractures are classified into 3 main types based on the gartland system can be either extension or flexion type. Jul 31, 2017 cervical spine trauma operative and nonoperative management david o.
Orthoguidelines management of hip fractures in the elderly. Children under three years of age typically sustain a supracondylar fracture after a fall from a height of less than 3 feet eg, fall from a bed or couch. Supracondylar soopruhkondehlahr femoral fracture also called distal distuhl femur fracture is when the thigh bone breaks at the knee. Some series report that open wounds are present in as many as 30% of these fractures. The arrows indicate where the bone is broken, and the elbow is no longer connected to the humerus. Apr 29, 2015 operative technique for supracondylar humerus fractures regular or table big carm flipped i. The treatment of displaced supracondylar humerus fractures ncbi. Associated injuries in adjacent joints may be noted.
A supracondylar fracture is an injury to the humerus, or upper arm bone, at its narrowest point, just above the elbow. Ap and lateral radiographs of the elbow demonstrate a lucency across the distal humerus consistent with a supracondylar fracture. Supracondylar fractures of the distal humerus are a commonly encountered injury in children. The backslab and sling should be placed under loose fitting clothing, not through the sleeve figure 1. The femur is the largest and strongest bone in the body. Treatment is usually closed reduction and percutanous pinning crpp, with the urgency depending on whether the hand remains perfused or not. Cast immobilization if an extension type of fracture then consider initially splinting into a 20 degree elbow flexion. They occur after a fall onto an outstretched arm, and they usually by falling off the monkeybars. Gartland classification of supracondylar humeral fractures. Periprosthetic fractures medical billing and coding. A fracture of the ulna associated with a dislocation of the top of the radius at the elbow is called a monteggia fracture. Welcome to the bluebook, the definitive style guide for legal citation in the. Supracondylar humerus fractures can be classified using the gartland.
Deep ulcer, penetrating down to ligaments and muscle, but no bone involvement or abscess formation. Reviewers guidance checklist for orthopedic external. Since 2008, california rules of court have allowed citations in bluebook form as well as the states own style manual, but many practitioners and courts continue to. Patients with supracondylar fractures will often have prolonged period months of inability to fully extend their elbow. The nondominant extremity is most commonly affected. Gartland type ii supracondylar fractures can sometimes have a significant displacement in the ap xray with either tilt or translation, which would indicate treatment according to the treatment protocol for type iii injuries.
Supracondylar humerus fractures clinical presentation. Gartland type iii supracondylar fracture of six year old girl. Type 2 there are differing opinions on the treatment of type 2 supracondylar humerus fractures. This edition of the blue book and the new national hip fracture. If treated quickly, either by immobilizing with a cast or by surgery, the. Classification of supracondylar humerus fractures in children. Complications of supracondylar fractures of the elbow. Supracondylar fractures are a very common type of broken elbow seen in kids, especially ages 38 years old. A description of the bluebooks structure of rules and tables additional to the one. Superficial ulcer involving the full skin thickness but not grade 2. Diagnosis and careful management of the fracture and arterial repair is crucial. Here are links to possibly useful sources of information about supracondylar humerus fracture. Clinical practice guidelines cpg provide evidencebased recommendations for current orthopaedic diagnostic, treatment, and postoperative procedures.
Twentyfour children with a pulseless maintained a well. Dec, 2011 supracondylar fractures in children dept. They are frequently caused by a fall on an outstretched elbow or a direct blow to the elbow. Operative technique for supracondylar humerus fractures regular or table big carm flipped i. Supracondylar femoral fracture central coast orthopedic. All words in case names, other than the first word of either partys name, is abbreviated if it is listed in table 6 on pages 30203 of the. Flexion type fractures result from a direct impact to the elbow region. Extension type of supracondylar humerus fractures typically result from a fall on to an outstretched hand, usually leading to a forced hyperextension of the elbow.
The aim of this study was to evaluate the recovery time of elbow range of motion after treatment of gartlands type ii and iii supracondylar fractures of distal humerus in children who attended a. Supracondylar and lateral condyle fractures of the humerus in. The backslab and sling should be placed under figure 2. True anteroposterior and lateral radiographs are essential not only for an accurate diagnosis, but also for creating a treatment plan for these injuries. They result in an extraarticular fracture line, and when displaced posterior displacement of the distal component. The aim of this study was to determine the prevalence and outcome of supracondylar fractures. Children more commonly suffer from this fracture than adults and it may cause serious complications if ignored.
Occult supracondylar humerus fractures are common and suspected when there is a history of trauma, tenderness in the supracondylar region, and a radiographic elbow effusion posterior fat pad sign. It take a great deal of force to break the thigh bone. Supracondylar fracture definition of supracondylar fracture. This type of fracture is referred to as a supracondylar humerus fracture. Jan 15, 2012 arterial damage is sometimes associated with supracondylar fractures of the humerus. Sickkids parent information sheet supracondylar humerus fracture without displacement. May 05, 2014 supracondylar fractures in children 1. The management of urological trauma associated with pelvic fractures the. These elbow fractures require only a backslab partial cast and sling. The olecranon acts as a fulcrum which focuses the stress on distal humerus supracondylar area, predisposing the distal humerus to fracture. It has been estimated that they account for approximately 65% of all fractures and dislocations in children. The pulseless pink hand after supracondylar fracture of the humerus in children. They occur in older individuals and require different management and are discussed separately.
If you have comments or questions, please contact jason kelecic, d. Arterial damage accompanying supracondylar fractures of the. Type i fracture is not displaced or minimally displaced. The guidelines provided answers for the following questions regarding the treatment for type iii supracondylar fractures 1 which is the preferred treatment for. Type 4 a controversial category describing a fracture that is unstable in flexion and extension, implying a lack of intact periosteum. The dashed blue line represents the anterior humeral line. If the dislocation is not recognized, and only the fracture is treated, it can lead to permanent impairment of elbow joint function. Rarely supracondylar fractures are seen due to a fall onto the flexed elbow. Citing other resources bluebook guide guides at georgetown. The association with neurovascular compromise and the potential problems of accurately reducing a displaced fracture can make treatment difficult particularly for the unwary surgeon. The gartland classification of supracondylar fractures of the humerus is based on the degree and direction of displacement, and the presence of intact cortex. Supracondylar fractures are the most common type of upper arm injury in children. Radiographs of the elbow show a displaced supracondylar fracture. Gartlands classification of supracondylar fracture of humerus galeazzi fracture a fracture of the radius with dislocation of the distal radioulnar joint colles fracture a distal fracture of the radius with dorsal posterior displacement of the wrist and hand smiths fracture a distal fracture of the.
Aug 23, 2019 the clinical presentation of a supracondylar humerus fracture schf is that of a painful swollen elbow that the patient is hesitant to move. The most popular abbreviation for supracondylar fracture is. A line drawn along the anterior border of the humerus does not intersect the middle third of the capitellum, indicating that the fracture is somewhat posteriorly angulated. Classification of supracondylar fractures is relatively straightforward and based on three types 67. But in rare cases when there is too much force with the fall like seen when falling off the monkeybars, our muscles that bend the elbow. There are different kinds of breaks, from simple to serious. Dec 18, 2017 supracondylar fracture of the humerus is a common childhood injury to the elbow.
A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. Gartlands classification of supracondylar fracture of humerus. This does not cause functional disability and should not be treated with physiotherapy. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. I have done my best to adhere to the following rules regarding how much. The extension type occurs when a child completely straightens their arm to brace for a fall, which sounds normal enough, and in most cases nothing happens. The elbow may appear angulated and the upper extremity shortened. In general, the gartland classification can be used for a basic treatment algorithm.
Hip fracture guideline companion consensus statements. Pdf supracondylar fractures of the humerus in children. Supracondylar fracture of the humerus is a common childhood injury to the elbow. Treatment may consist of placement of a long arm cast with close followup or closed reduction and percutaneous pinning. Supracondylar fracture pediatric pediatrics orthobullets. Clinical examination initial gross assessment should be aimed to rule out any associated systemic trauma and neurovascular involvement.
If treated quickly, either by immobilizing with a cast or by surgery, the prospects for full recovery are very good. In a series of 33 pulseless supracondylar fractures, we recently reported that preoperative hand perfusion is the key predictor of outcome. Typically supracondylar fractures occur as a result of a fall on a hyperextended elbow. Care of patients with fragility fracture blue book british geriatrics. Supracondylar humeral fracture radiology reference article. Type i nondisplaced or minally displaced fracture on the lateral view.
Outerbridgekashiwagi procedure for the treatment of a. The radial nerve lies posterolateral to the usual location of supracondylar fractures and, thus, is less commonly involved see fig. This is a type of fracture that is most common in children but one that you rarely see in an adult but may occur in the elderly who are suffering from weakened bones or osteoporosis. Surgery for type 3 supracondylar fractures has evolved significantly in the past 20 years.
Supracondylar fractures of the humerus in children clinical. Pediatric supracondylar fractures of the distal humerus. There are too many rules for this introductory guide to. It applies to extension supracondylar fractures rather than the rare flexion supracondylar fracture. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. Supracondylar fracture types, treatment, classification.
May 10, 2008 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. Nonphyseal supracondylar fractures of the femur are considered to be uncommon in children and have received little attention in the literature. Most common fracture around the elbow in children 60 percent of elbow fractures peak age between 5 and 7 years boys had a higher incidence at the peak age for supracondylar fractures, there is a naturally occurring hyperextension of the elbow, which predisposes the distal humerus to this type of fracture. When a broken bone breaks through the skin, it is called an open fracture. This is an xray of the most severe type of supracondylar fracture, a type 3. Cervical spine trauma operative and nonoperative management david o. Supracondylar humerus fractures pediatric orthopaedic. Supracondylar humeral fracture radiology reference. Supracondylar fractures result from a fall on an outstretched arm in up to 70 percent of patients. 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.
Kids broken elbow supracondylar fracture bone talks. Supracondylar humerus fractures are the most common elbow fracture in children and most often. Jan 28, 2019 supracondylar fracture occurs commonly in distal humerus. The following is taken from the blue books executive summary. Raise the arm on a pillow when sitting or lying down loose fitting clothing, not through the sleeve. Ideal sources for wikipedia s health content are defined in the guideline wikipedia. Hyperextension of the elbow causes an extension type supracondylar fracture seen in 95% of cases.644 564 1628 999 1671 17 7 1617 916 239 89 1111 671 640 141 1485 965 274 1074 641 1022 106 125 910 286 275 1413 1157