Epidemiology. Pediatric Pelvis Trauma Radiographic Evaluation, Pediatric Hip Trauma Radiographic Evaluation, Pediatric Knee Trauma Radiographic Evaluation, Pediatric Ankle Trauma Radiographic Evaluation, Distal Humerus Physeal Separation - Pediatric, Proximal Tibia Metaphyseal FX - Pediatric, Chronic Recurrent Multifocal Osteomyelitis (CRMO), Obstetric Brachial Plexopathy (Erb's, Klumpke's Palsy), Anterolateral Bowing & Congenital Pseudoarthrosis of Tibia, Clubfoot (congenital talipes equinovarus), Flexible Pes Planovalgus (Flexible Flatfoot), Congenital Hallux Varus (Atavistic Great Toe), Cerebral Palsy - Upper Extremity Disorders, Myelodysplasia (myelomeningocele, spinal bifida), Dysplasia Epiphysealis Hemimelica (Trevor's Disease), e.g., internal (medial epicondyle) apophysis, ossifies/appears at age 6 years (table below), fuses at age ~ 17 years (is the last to fuse), AP and lateral x-ray of the elbow (really of the distal humerus), lucency on a lateral view along the posterior distal humerus and olecranon fossa is highly suggestive of occult fracture around the elbow, displacement of the anterior humeral line, anterior humeral line should intersect the middle third of the capitellum in children, capitellum moves posteriorly to this reference line in extension type fractures and anteriorly in flexion type fractures, Baumann's angle is created by drawing a line parallel to the longitudinal axis of the humeral shaft and a line along the lateral condylar physis as viewed on the AP image, normal is 70-75°, but best judge is a comparison of the contralateral side, deviation of >5-10° indicates coronal plane deformity and should not be accepted, time to CRPP dictated by neurovascular status, some argue can treat an isolated AIN injury in non-urgent fashion, splint in 30-40° elbow flexion, admit overnight for observation and elevation for elective surgery, ecchymosis, dimpling/puckering antecubital fossa, palpable subcutaneous bone fragment, indicates proximal fragment buttonholed through brachialis, implies more serious injury, higher likelihood of arterial injury, significant swelling, more difficult closed reduction, ipsilateral supracondylar humerus and forearm/wrist fractures warrant timely pinning of both fractures to decrease the risk of, if evidence of good distal perfusion admit for 48 hours of observation, if not well perfused perform vascular exploration, if well perfused admit and observe for 48 hours, open exploration and reduction if vascular status does not improve, more frequently required with flexion type fractures (compared to extension type), pulseless white OR pink hand that is unable to be reduced or there remains a gap, gap might represent entrapped vascular structure, posteromedial displacement: forearm pronated with hyperflexion, posterolateral displacement: forearm supinated with hyperflexion, if pronation or supination does not work, try the opposite, maximize separation of pins at fracture site, engage both medial & lateral columns proximal to fracture, engage sufficient bone in proximal & distal segments, biomechanically stronger in bending and torsion than 2-pin constructs, biomechanically strongest to torsional stress, anterior approach if pulseless or median nerve injury, a lateral or medial approach where periosteum is torn, never posterior as posterior dissection can --> AVN, identify median nerve and brachial artery, 2 or 3 K-wires depending on the degree of stability, mechanism = tenting of nerve on fracture, or entrapment in the fracture site, decision to explore is based on quality of extremity, arteriography is NOT indicated in isolated injuries, role of doppler is unclear and does not change treatment, may result from elbow hyperflexion casting. What is the optimal initial treatment for this injury based on the AAOS guidelines? 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) Five fractures were undisplaced and easily managed. This type of nerve palsy prevents the ability of the patient to adequately perform an “A-OK” sign but often resolves spontaneously. Tested Concept, (OBQ12.112) Tested Concept. Pediatric lateral condyle fracture is an injury in the elbow that is often missed or mistaken for a supracondylar humerus fracture (SCHF). The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. An Inconclusive recommendation means that there is a lack Supracondylar humerus (SCH) fractures are reported to be approximately twice as common among boys as among girls. Although the bony architecture of the distal humerus is responsible for the frequency of supracondylar humeral fractures, it is the soft tissue anatomy that has the potential to produce devastating long-term complications. Elbow ossification centers (CRITOE) - radiology video tutorial - Duration: 6:02. 2004 Apr. Tested Concept, (OBQ04.225) The Gartland classification of supracondylar fractures of the humerus is based on the degree and direction of displacement, and the presence of intact cortex.It applies to extension supracondylar fractures rather than the rare flexion supracondylar fracture.. (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. Supracondylar fractures are the most common upper extremity fracture in the pediatric population therfore every emergency medicine provider should be deeply familiar with the known complications of such pathology. New to Orthobullets? In these more challenging cases, the surgeon may need to perform an open reduction. Implant B is better able to control fractures with a small distal segment than Implants A and C. Implant C is better able to control coronal plane fractures than Implants A and B. Classification. In most instances, pediatric supracondylar humerus fractures (SCHFs) result from a fall on outstretched hand with the elbow hyperextended. Although these injuries are relatively rare, most orthopedic surgeons are called upon to evaluate and treat patients with these injuries and, therefore, must be equipped to achieve optimal outc… This is an AAOS Self Assessment Exam (SAE) question. The distal humerus bone breaks with a trauma c event, … Late surgical treatment of posttraumatic cubitus varus (gunstock deformity) is usually necessitated by the patient reporting problems related to Radiographs of the wrist show an extra-articular distal radius fracture with 25 degrees of dorsal angulation. [] It is essential that a true lateral elbow image be obtained as part of … This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. Tested Concept, Sagittal plane fracture of the medial femoral condyle, Coronal plane fracture of the lateral femoral condyle, Axial plane fracture through the medial femoral condyle, (OBQ05.145) Radiographs and representative CT scan images are shown in Figures A-D. What is the most appropriate treatment method for this patient's injury? AP and lateral radiographs are provided in Figure A. A 7-year-old boy falls off the playground and sustains the injury shown in figure A. Tested Concept, Retrograde femoral nailing with adjunct BMP-4, Hybrid external fixation with adjunct BMP-4, Usage of a percutaneous locking plate with adjunct BMP-3, Open reduction and plating with autograft, Open reduction and plating with adjunct calcium phosphate, (OBQ06.70) Background: Supracondylar fractures of the distal humerus are the most common fractures about the elbow seen in children. Radiographs are shown in Figures 6a and 6b. In children, many of these fractures are non-displaced and can be treated with casting. incidence A 6-year-old presents with an elbow deformity after falling from the monkey bars. Radiographs of the elbow show a displaced supracondylar fracture. She is neurovascularly intact and the skin shows no evidence of open wounds. Healing results in a mild gunstock deformity. Tested Concept, (OBQ13.239) Tested Concept, (OBQ08.196) A pediatric SCH fracture is the most common elbow injury in children. The work group recognizes that a percentage of pediatric supracondylar fractures of the humerus cannot be reduced using a closed technique. The skin is intact and no evidence of puckering is seen. The nerve most commonly affected by this fracture pattern innervates which of the following motor groups? Currently we only have videos for one procedure posted. 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. Epidemiology. The supracondylar region is the weakest point in the developing elbow and therefore is commonly injured. First ensure correct film, views, and the films are technically adequate, assessment should include: Lateral view: demonstrates an obvious fracture line on the anterior supracondylar region of the humerus, less than 1/3 of the capitellum is anterior to the anterior humeral line.There is also raised posterior and anterior fat bad and surrounding soft tissue swelling. Lateral-entry pin fixation in the management of supracondylar fractures in children. Tags: elbow, vascular

 

1 Tested Concept, Medial opening-wedge osteotomy with medialization of the distal fragment, (OBQ11.67) They are distinctly different from adult SCHFs and … A pediatric SCH fracture is the most common elbow injury in children. The annual incidence of supracondylar fractures has been estimated at 177.3 per 100,000. 1. Supracondylar humeral fractures may often present without evidence of fracture lines on diagnostic imaging. immediate electromyography and nerve conduction velocity studies. What is the advantage of medial and lateral crossed pins compared to two lateral pins in the treatment of supracondylar humerus fractures? The anteroposterior radius of curvature for the Zimmer, the long Gamma, and the Synthes nail are 257 cm, 300 cm, and 150 cm, respectively. treatment is usually closed reduction and percutanous pinning (CRPP), with the urgency depending on whether the hand remains perfused or not. Functional deficit is minimal but the cosmetic effect can be considerable.Figure 1: potential for injury to popliteal artery if significant displacement; Ankle-brachial index (ABI) should be performed if there is a concern for vascular injury . 86-A (4):702-7. Examination in the emergency department reveals that he is unable to flex the interphalangeal joint of his thumb and the distal interphalangeal joint of his index finger. What is a supracondylar humerus fracture? Figures A through E are injury radiographs of elbow injuries in children. Clinically, it is important to differentiate between an SCHF (extra-articular) and a lateral condyle fracture (intra-articular). Tested Concept, (OBQ08.248) Boyer K; American Academy of Orthopaedic Surgeons. Which of the following is the most appropriate clinical scenario to utilize locking plate and screw technology? 2012 Feb;20(2):69-77. They result from force applied across the elbow, usually following a fall. 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. Supracondylar humerus fractures almost exclusively affect the immature skeleton. type supracondylar humeral fracture in children. A 68-year-old healthy active male presents after falling and sustaining an injury to his right knee. Tested Concept, Greater ultimate clinical arc of elbow motion, Greater experimental biomechanical stability, (SAE07PE.16) 26 The peak age for supracondylar humerus fracture has been reported to be between the ages of 6 and 7 years, and the left arm is injured more frequently than the right. Mastery Trigger: Check the "Mark Skill as Read" under each Step. The treatment of 14 children with flexion-type supracondylar humeral fracture was reviewed. The supracondylar humerus fracture is the most common elbow fracture in children, accounting for more than half of all pediatric elbow fractures 39, 40 and 3% to 18% of all fractures seen in children. It constitutes about 65.4% of all the fractures about the elbow in children. AAOS Clinical Practice Guidelines: The treatment of pediatric supracondylar humerus fractures. 2001 May. 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. The most common associated injury with supracondylar fractures is a neuropraxia involving the anterior interosseus branch of the median nerve. ... Is medial pin use safe for treating pediatric supracondylar humerus fractures? » 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. Supracondylar nonunions may be associated with deformity depending on the time from injury and the durability of the implants used to stabilize the distal femur. The consequences of pin placement. 1 INTRODUCTION. Supracondylar fractures are the most common pediatric elbow fracture and carry significant potential for neurovascular compromise [].These fractures of the distal humerus are frequently problematic in terms of diagnosis, treatment, and complications [].Proper care requires appropriate assessment and prompt orthopedic care for those patients whose fractures pose … MalunionThe typical deformity is a varus malalignment (cubitus varus or gunstock deformity). For less than 5 % supracondylar fracture orthobullets all the fractures about the elbow ( supracondylar.. That the intercondylar screws are contained within the bone and are best treated with casting a presents... 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