Of the 44 included studies in this clinical practice guideline, only 7 were rcts. A supracondylar fracture is an injury to the humerus, or upper arm bone, at its narrowest point, just above the elbow. Supracondylar humeral fracture radiology reference article. Dec, 2011 the end of gout is a short, to the point guide on how to reverse gout symptoms without ever leaving your home. Supracondylar fractures of the humerus are one of the most common fractures of childhood. This may cause the patient to cradle the affected arm to protect the injury. Management of supracondylar fractures of the humerus in children. In order to avoid the potential pitfalls in the evaluation and management of these patients, a systematic approach must be adopted. 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 understanding of the pathology and management of this. Management of vascular injuries in displaced supracondylar humerus fractures without arteriography. Supracondylar fracture of the humerus emergency department. At the time of injury, a supracondylar fracture typically causes a sudden onset of intense, often sharp, elbow or upper arm pain. Ed management of supracondylar fractures of the distal humerus.
Despite being the most common fracture of the elbow in children, highquality scientific data regarding the treatment of pediatric supracondylar humerus fractures are lacking. Supracondylar fracture teachmesurgeryteachmesurgery. In a study of 4536 consecutive fractures in adults seen in the massachusetts general hospital emergency department, only 0. Pdf management of supracondylar fractures of the humerus. Supracondylar humerus fractures are the most common elbow fractures in the pediatric population. In the printed or pdf version of this article, author affiliations can be found at the. Distal humerus fractures of the elbow orthoinfo aaos. She is neurovascularly intact and the skin shows no evidence of open wounds.
Supracondylar humerus sch fractures are the most common. These injuries require early surgical treatment, ideally on the day of admission. Supracondylar fractures of the humerus are one of the most common. The utility of radiographs prior to pin removal after operative treatment of supracondylar humerus fractures in children.
However, a bilateral sch is rarely observed in this age group. Clinical practice guideline on the treatment of pediatric supracondylar humerus fractures. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. Most common elbow fractures seen in children 5 to 6yrs boys vs gals 3. Crossed wires versus two lateral wires in management of supracondylar fracture of the humerus in children in the hands of junior trainees. Aug 23, 2019 distal humerus fractures in adults are relatively uncommon injuries, representing only about 3% of all fractures in adults. The effect of humeral length visualized on the xray. About 10% to 20% of displaced supracondylar fractures. Supracondylar fractures of the humerus in children british. Pcp quick reference guide references clinical improvement team target population inclusion criteria patients with supracondylar humerus fracture sch fx exclusion criteria not applicable initial evaluation, clinical management and imaging clinical assessment. Fracture, supracondylar humerus childrens hospital colorado. 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. They are considered serious injuries because of the risk of neurovascular injury or malunion.
Supracondylar fracture fractured humerus physioadvisor. Distal humerus fractures orthopaedic trauma association ota. This is the most common upper extremity fracture pattern in younger children, and. The backslab and sling should be placed under figure 2. Supracondylar humeral fracture radiology reference. The surgical approach was made through the torn soft tissues without further destabilizing or devascularizing the. Supracondylar humeral fractures account for 60 percent of fractures near the elbow among children. Supracondylar fractures of the humerus are the most common fracture pattern of the elbow in children. Management of supracondylar fractures of the humerus in. Late presentation of supracondylar fracture of the humerus in children. Type 5 is a type 4 with fracture of medial condyle. Lateral entry pins provide stable fixation, avoiding the risk of iatrogenic ulnar nerve injury.
In 1956, lipscomb noted that supracondylar fractures were the cause of 48% of volkmanns contractures in 92 cases from the mayo clinic. Treatment is usually closed reduction and percutanous pinning crpp, with the urgency depending on whether the hand remains perfused or not. Management of displaced extensiontype supracondylar fractures of the humerus in children. Type i fractures are managed nonsurgically, but most displaced injuries types ii, iii, and iv require surgical intervention. The effectiveness of physiotherapy after operative treatment of supracondylar humeral fractures in children. A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. Type 5 is a type 4 with fracture of medial condyle osteoporoticbone can be associated with undisplaced supercondylar fx. Supracondylar humerus fracture sch is common in the pediatric age group 57 years, mostly due to a fall on an outstretched hand. Evidencebased information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain the best. The treatment of pediatric supracondylar humerus fractures is controversial, but despite the injurys high incidence there is a lack of high level evidence to guide operative versus nonoperative decision making for displaced fractures with an intact posterior cortex gartland type ii. Supracondylar fractures of the humerus in children longdom. Pdf supracondylar fracture of the humerus in children. Pediatric supracondylar humerus fractures springerlink. Supracondylar fractures of the distal humerus are the most common fractures.
Aug 27, 2018 these are the two guidelines authors found useful in the diagnosis and treatment of supracondylar humerus fractures. Supracondylar humerus fractures pediatric orthopaedic. The treatment of pediatric supracondylar humerus fractures. Pdf management of supracondylar fractures of the humerus in. A distal humerus fracture is a break in the lower end of the upper arm bone humerus, one of the three bones that come together to form the elbow joint.
Closed reduction and percutaneous pinning remains the mainstay of surgical management. Severely displaced supracondylar fractures of the distal humerus in children are a challenging problems. Typically supracondylar fractures occur as a result of a fall on a hyperextended elbow. Article pdf available january 2016 with 2,725 reads. Management of the pediatric pulseless supracondylar. Rarely supracondylar fractures are seen due to a fall onto the flexed elbow. All agree that a patient who presents with no palpable radial pulse because of a supracondylar humeral fracture requires timely reduction of the fracture 1. Pdf supracondylar fractures of the humerus in children. Evidencebased information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain the best outcomes while considering the subtleties and. Supracondylar humerus information sheet appendix c.
Anatomic articular reduction and provisional fixation. Supracondylar fracture pediatric pediatrics orthobullets. Accessed 19032019 vaqueropicado a, gonzalezmoran g, moraleda l. Appropriate use criteria for the management of pediatric supracondylar humerus fractures. For extensiontype supracondylar fractures, management is guided by the gartland classification system and clinical examination e. Complications of supracondylar fractures of the elbow.
There is an intervening thin area of bone connecting the olecranon fossa and coronoid fossa, which is the location of most supracondylar humerus fractures. The lateralpin also has an added advantage that it can be removed easily. One from the royal childrens hospital in melbourne australia, and one published on the american academy of orthopaedic surgeons guidelines. Supracondylar humerus fractures and brachial artery injuries. Closed supracondylar humerus fracture in children with pulseless hand though appear to have vascularity even after skeletal stabilisation may need surgical exploration for addressing vascular injury which is often accomplished by thrombectomy. Surgical management for late presentation of supracondylar.
Clinical practice guidelines cpg provide evidencebased recommendations for current orthopaedic diagnostic, treatment, and postoperative procedures. Distal humerus fractures orthopaedic trauma association. Appointments no pt for 3 weeks, unless otherwise specified by md rehabilitation goals modalities to control pain and swelling protect fracture site maintain rom in surrounding joints prevent deconditioning. Undisplaced gartland type i or minimally displaced fractures in children can potentially be. Fracture that involves the epiphyseal plate or growth plate of a bone type i. Underreduced supracondylar fracture of the humerus in children. To report the results of surgical management for latepresenting displaced supracondylar fractures of the humerus in children. Supracondylar fractures of the humerus have been recognised since the time of hippocrates and are one of the more common fractures in children.
They occur in older individuals and require different management and are discussed separately. Pediatric supracondylar humerus fractures guidelines. Anatomy of the distal humerus includes medial and lateral columns. The value of ultrasonic diagnosis in the management of vascular complications of supracondylar fractures of the humerus in children. Raise the arm on a pillow when sitting or lying down loose fitting clothing, not through the sleeve. Though commonly encountered in clinical practice, pediatric supracondylar humerus fractures can be challenging to treat. Supracondylar fractures are the most common type of upper arm injury in children. Management of supracondylar humerus fractures in children. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. Phase ii orthopedic assessment and management pg 1 inclusion criteria supracondylar humerus fractures exclusion criteria polytra uma adult type tcondyla r or supracondylar fracture metabolic bone disease bone afragility conditions pathologic fractures supracondylar humerus fractures v1. Cold therapy ice will reduce pain and will help with swelling. Orif of distal humerus or supracondylar fracture discharge instructions comfort discomfort increases 2448 hours after surgery due to the injected numbing medication wearing off.
Multidisciplinary clinician work groups and aaos staff work together to synthesize published research. A particular subset of pediatric extremity vascular injuries is the pink pulseless hands associated with supracondylar humerus fractures. Supracondylar fractures of the humerus associated with ipsilateral forearm fractures in children. A fracture in this area can be very painful and make elbow motion difficult or impossible. 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 humerus linkedin slideshare. Type ii, type iii, and type iv supracondylar fractures will nearly always require a closed reduction and percutaneous kwire fixation. Documentation of neurovascular status in supracondylar. Full appropriate use criteria pdf on the management of pediatric supracondylar humerus fractures. Dec 18, 2017 a supracondylar fracture is an injury to the humerus, or upper arm bone, at its narrowest point, just above the elbow.
The american academy of orthopaedic surgeons has developed the appropriate use criteria auc document management of pediatric supracondylar humerus fractures with vascular injury. Many treatment methods have been described for the treatment of displaced supracondylar fractures of the humerus, however, it has not been reached a consensus for. Detail treatment guidelines for pediatric supracondylar fractures. Gartland classification modified type 1 nondisplaced. Gartlands classification of supracondylar fracture of humerus. The guide goes into extensive detail on exactly what you need to do to safely, effectively and permanently get rid of gout, and you are guaranteed to see dramatic improvements in days if not hours.
Oct 01, 2018 the socalled floating elbow occurs when the supracondylar fracture of the humerus is associated with an ipsilateral forearm fracture. Supracondylar fractures of the humerus sciencedirect. Supracondylar fractures may have significant complications including nerve injury, vascular injury, malunion and compartment syndrome 3. Humeral supracondylar fracture an overview sciencedirect. Many treatment methods have been described for the. Type ii, type iii, and type iv supracondylar fractures will nearly always require a closed reduction and percutaneous k. This is an uncommon situation approximately 5% of the supracondylar fractures that reflects highenergy trauma. Pediatric supracondylar humerus fractures journal of hand surgery. Conservative management can be trialled with type i fractures or minimally displaced type ii fractures, which can be managed in an above elbow cast in 90 degrees flexion. The fracture is a metaphyseal injury that does not involve the physis or. 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. Supracondylar fractures of the humerus are the most common fractures in children. Supracondylar fractures of the humerus are the most frequent fractures affecting the paediatric elbow 1 and their correct management is important because they can cause catastrophic complications.
Supracondylar fracture often present with associated forearm fractures, soft tissue damage, neurologic injury, and significant risk for developing compartment syndrome, thus examination of the entire upper extremity should be performing including. Despite there being a clear consensus about some issues regarding proper treatment of these fractures, controversy remains with regard to aspects such as the fact that there is no good. Radiographs of the elbow show a displaced supracondylar fracture. Management of pediatric supracondylar humerus fractures. Pdf supracondylar fractures of the humerus are the most frequent fractures of the paediatric elbow, with a peak incidence at the ages of five. This is the most common upper extremity fracture pattern in younger children, and the vascularinjury rate is as high as 10%.
422 1086 982 678 949 1060 238 704 123 1218 197 630 916 233 645 885 728 1507 154 775 1012 1245 847 938 950 108 196 82 1326 959 811 1164 194