[2] Meanwhile, for pink, pulseless hand (absent radial pulse but with good perfusion at extremities) after successful reduction and percutaneous pinning, the patient could still be observed until additional signs of ischaemia develops which warrants a surgical exploration. J Bone Joint Surg Am. In general, the Gartland Classification can be used for a basic treatment algorithm. Bleeding at the fracture results in a large effusion in the elbow joint. Management of Supracondylar Humerus Fractures in Children: Current Concepts. displacement of the anterior humeral line anterior humeral line should intersect the middle third of the capitellum in children > 5 years old, and touches the capitellum in children in children <5. In children, most of these fractures can be treated effecti… Scannell BP, Jackson B, Bray C, Roush TS, Brighton BK, Frick SL. Between May 2002 and November 2005 we performed this technique in 69 consecutive patients. Orthopaedic cast and extreme flexion should be avoided to prevent compartment syndrome and vascular compromise. 2001; 21 (5): 680-688. Some surgeons use lateral-only pins to avoid iatrogenic ulnar nerve injury. Splinting of fracture site with full flexion or extension of the elbow is not recommended as it can stretch the blood vessels and nerves over the bone fragments or can cause impingement of these structures into the fracture site. 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 triceps is elevated off the posterior humerus, but its insertion is not disturbed. J Bone Joint Surg Am 2007;89(4):706-712. [2], Gartland III and IV are unstable and prone to neurovascular injury. Supracondylar humeral fractures in children. [2], Absence of radial pulse is reported in 6 to 20% of the supracondylar fracture cases. Elbow imaging includes AP and lateral radiographs of the elbow. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. Subscribe to the link above using your browser or your favorite RSS reader. This provides adequate exposure for reduction and fixation. Neurologic deficits are found in 10-20% of patients. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. Conclusion: In cases of pediatric supracondylar humerus fracture, early closed reduction and percutaneous pinning is preferred; however, when this method is not applicable, triceps-splitting posterior approach is a safe and comparable method to lateral approach with advantages of easier fracture reduction and shorter operating time. [2], It is important to check for viability of the affected limb post trauma. [2] Meanwhile, the flexion-type of supracondylar humerus fracture is less common. Patients with any of the above risk factors should be observed carefully. If the proximal humerus is suspected to have pierced the brachialis muscle, gradual traction over the proximal humerus should be given instead. Common fracture treated by pediatric orthopaedic surgeons. [1] Some of these injuries can be complicated by poor healing or by associated blood vessel or nerve injuries with serious complications. If lateral condyle appears posterior to this line, it indicates the posterior displacement of lateral condyle. AP and lateral radiographs of the forearm are obtained to rule out associated fractures of the forearm (floating elbow). Both methods gives similar pain scores and activity level at two weeks of treatment. It is the angle between the line perpendicular to the long axis of the humerus and the growth plate of the lateral condyle. Bae DS, Kadiyala RK, Waters PM. With severe displacement, there may be an anterior dimple from the proximal bone end trapped within the biceps muscle. The perfusion status of the extremity should be noted. White L, Mehlman CT, Crawford AH. 20(2):69-77, February 2012. Acute compartment syndrome in children. However, medial and lateral pins insertions are able to stabilise the fractures more properly than lateral pins alone. Some are angulated or displaced and are best treated with surgery. This is evidenced by the weakness of the hand with a weak "OK" sign on physical examination (Unable to do an "OK" sign; instead a pincer grasp is performed). J Pediatr Orthop B 2009;18(2):93-98. Traction, closed reduction and splint, closed reduction and percutaneous pinning, open reduction and k-wire fixation are among the treatment options for these fractures. Prospective, surgeon randomized evaluation of crossed pins versus lateral pins for unstable supracondylar humerus fractures in children. Distal fragment goes posterolaterally. Keywords: Supracondylar humeral fracture, Posterior and lateral approach, Children Supracondylar humeral fractures are the most common fracture of the elbow region in the first decade of children(1). This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. Clinical parameters such as temperature of the limb extremities (warm or cold), capillary refilling time, oxygen saturation of the affected limb, presence of distal pulses (radial and ulnar pulses), assessment of peripheral nerves (radial, median, and ulnar nerves), and any wounds which would indicate open fracture. [2] There are two definitions of Bowmann's angle: The first definition of Baumann's angle is an angle between a line parallel to the longitudinal axis of the humeral shaft and a line drawn along the lateral epicondyle. Limb vascular status is categorized as "normal," "pulseless with a (warm, pink) perfused hand," or "pulseless–pale (nonperfused)" (see "neurovascular complications" below). AP radiograph – Baumann’s angle, assess medial comminution, Lateral radiograph – anterior humeral line, posterior fat pad sign, Fractures may be extension (≥95%) or flexion type, dependent upon the mechanism of injury. [2], "Fracture Supracondylar Humerus: A Review", "Low incidence of flexion-type supracondylar humerus fractures but high rate of complications", "Intraoperative assessment of Baumann's angle and carrying angles are very good prognostic predictors in the treatment of type III supracondylar humerus fractures in children", "Elbow your way into reporting paediatric elbow fractures – A simple approach", https://en.wikipedia.org/w/index.php?title=Supracondylar_humerus_fracture&oldid=984871230, Articles with unsourced statements from October 2020, Creative Commons Attribution-ShareAlike License, An elbow X-ray showing a displaced supracondylar fracture in a young child, Medial periosteal hinge intact. posterior fat pad sign is often present (16). Every 5 degrees change in Bowmann's angle can lead to 2 degrees change in carrying angle. Important findings include warmth, capillary refill, and the presence or absence of a radial pulse by palpation and/or Doppler ultrasound. This page was last edited on 22 October 2020, at 16:18. This is because the proximal fragment will be displaced antero-laterally. The supracondylar area undergoes remodeling at the age of 6 to 7, making this area thin and prone to fractures. Distal fragment goes posteromedially, Lateral periosteal hinge intact. Although Gartland Type III fractures with posteromedial displacement of distal fragment can be reduced with closed reduction and casting, those with posterolateral displacement should preferably be fixed by percutaneous pinning. Therefore, early surgical reduction is indicated to prevent this type of complication. [3], Diagnosis is confirmed by x-ray imaging. There is pain and swelling about the elbow. [2], A puckered, dimple, or an ecchymosis of the skin just anterior to the distal humerus is a sign of difficult reduction because the proximal fragment may have already penetrated the brachialis muscle and the subcutaneous layer of the skin. J Bone Joint Surg Am. [2], Supracondylar humerus fractures is commonly found in children between 5 and 7 years (90% of the cases), after the clavicle and forearm fractures. J Pediatr Orthop. The capitulum of the humerus is the first to ossify at the age of one year. [2][7], Tear drop sign - Tear drop sign is seen on a normal radiograph, but is disturbed in supracondylar fracture. Objective: To determine the functional outcome of posterior triceps muscle sparing versus muscle splitting approach in supracondylar humerus fracture in children. In children, many of these fractures are non-displaced and can be treated with casting. The need for range of motion exercises or formal physical therapy is controversial. [6] An angle of more than 10° is regarded as acceptable. X-ray of the forearm (AP and lateral) should also be obtained for because of the common association of supracondylar fractures with the fractures of the forearm.

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