Diferencia entre revisiones de «Supracondylar fracture»
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Sin resumen de edición |
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** Due to direct trauma to posterior aspect of flexed elbow | ** Due to direct trauma to posterior aspect of flexed elbow | ||
==Physical Findings== | ==Diagnosis== | ||
* Do not encourage active/passive elbow movement until displaced fx has been ruled-out | ===Physical Findings=== | ||
* Pain, swelling, very limited | *Do not encourage active/passive elbow movement until displaced fx has been ruled-out | ||
* Nondisplaced fx may have limited swelling, but child will refuse to move arm | *Pain, swelling, very limited range of motion | ||
* Posterior distal humerus TTP usually found in these patients | *Nondisplaced fx may have limited swelling, but child will refuse to move arm | ||
* If evidence of S-shape configuration or skin dimpling, | *Posterior distal humerus TTP usually found in these patients | ||
*If evidence of S-shape configuration or skin dimpling, splint before xray | |||
== | ===Imaging=== | ||
*True lateral elbow | |||
**Anterior humeral line should intersect with middle third of capitellum | |||
***If not, consider supracondylar fx or lateral condyle fx | |||
**Line drawn along axis of radial head and neck should pass through middle of capitellum | |||
***If not, consider fx of lateral condyle, radial neck, Monteggia, or elbow dislocation | |||
**Fat Pads | |||
***Anterior may be normal or if large may be abnormal ("sail sign") | |||
***Posterior is always abnormal | |||
*Forearm/wrist views | |||
**Co-injuries are common w/ elbow fx | |||
Type III: Displaced w/ disruption of anterior and posterior periosteum | ==Gartland Classification== | ||
*Type I: Nondisplaced with evidence of elbow effusion (ant. sail and/or post. fat pad) | |||
* No continuity between the proximal and distal fracture fragments | *Type II: Displaced w/ intact posterior periosteum (ant. humeral line is displaced anteriorly rel. to capitellum) | ||
* Direction of displacement is important in predicting neurovascular injury | *Type III: Displaced w/ disruption of anterior and posterior periosteum | ||
**No continuity between the proximal and distal fracture fragments | |||
**Direction of displacement is important in predicting neurovascular injury | |||
==Treatment== | ==Treatment== | ||
* Type I | *Type I | ||
** Immobilize using a posterior splint and sling (extend from wrist to axilla) | **Immobilize using a posterior splint and sling (extend from wrist to axilla) | ||
** Refer to ortho within 1 week | **Refer to ortho within 1 week | ||
* Type II & III | *Type II & III | ||
** Orthopedic consultation regarding closed versus open reduction w/ percutaneous pinning | **Orthopedic consultation regarding closed versus open reduction w/ percutaneous pinning | ||
** Admit | **Admit | ||
==Complications== | ==Complications== | ||
===Vascular=== | ===Vascular=== | ||
* Absenst radial pulse in 10-20% of cases | *Absenst radial pulse in 10-20% of cases | ||
* Need to rule-out compartment syndrome | *Need to rule-out compartment syndrome | ||
* Occurs more commonly when forearm is also fractured | *Occurs more commonly when forearm is also fractured | ||
* Ecchymosis over anteromedial aspect of forearm suggests brachial artery injury | *Ecchymosis over anteromedial aspect of forearm suggests brachial artery injury | ||
* Rare with type I fx | *Rare with type I fx | ||
===Neurologic=== | ===Neurologic=== | ||
* Median nerve injury | *Median nerve injury | ||
** Weakness of hand flexors | **Weakness of hand flexors | ||
** Loss of two-point sensation on palmar surface of thumb, IF, MF | **Loss of two-point sensation on palmar surface of thumb, IF, MF | ||
** Anterior interosseous nerve is branch of median nerve most often affected | **Anterior interosseous nerve is branch of median nerve most often affected | ||
** Forearm pain + difficulty making "ok" sign | **Forearm pain + difficulty making "ok" sign | ||
* Radial nerve injury | *Radial nerve injury | ||
** Weakness of wrist extension, hand supination, and thumb extension (thumbs up) | **Weakness of wrist extension, hand supination, and thumb extension (thumbs up) | ||
** Altered sensation in dorsal web space between thumb and index finger | **Altered sensation in dorsal web space between thumb and index finger | ||
* Ulnar nerve injury | *Ulnar nerve injury | ||
** May occur with flexion type fractures | **May occur with flexion type fractures | ||
** Weakness of wrist flexion and adduction, finger spread, flexion of pinky DIP | **Weakness of wrist flexion and adduction, finger spread, flexion of pinky DIP | ||
** Altered sensation of ulnar side of ring/pinky | **Altered sensation of ulnar side of ring/pinky | ||
** Majority of nerve injuries are neurpraxias without long-term sequelae | **Majority of nerve injuries are neurpraxias without long-term sequelae | ||
==See Also== | ==See Also== | ||
Revisión del 00:31 27 jun 2011
Mechanism of Injury
- Extension-type fractures
- 95% of suprcondylar fractures
- Due to FOOSH
- Flexion-type fractures
- 5% of supracondylar fractures
- Due to direct trauma to posterior aspect of flexed elbow
Diagnosis
Physical Findings
- Do not encourage active/passive elbow movement until displaced fx has been ruled-out
- Pain, swelling, very limited range of motion
- Nondisplaced fx may have limited swelling, but child will refuse to move arm
- Posterior distal humerus TTP usually found in these patients
- If evidence of S-shape configuration or skin dimpling, splint before xray
Imaging
- True lateral elbow
- Anterior humeral line should intersect with middle third of capitellum
- If not, consider supracondylar fx or lateral condyle fx
- Line drawn along axis of radial head and neck should pass through middle of capitellum
- If not, consider fx of lateral condyle, radial neck, Monteggia, or elbow dislocation
- Fat Pads
- Anterior may be normal or if large may be abnormal ("sail sign")
- Posterior is always abnormal
- Anterior humeral line should intersect with middle third of capitellum
- Forearm/wrist views
- Co-injuries are common w/ elbow fx
Gartland Classification
- Type I: Nondisplaced with evidence of elbow effusion (ant. sail and/or post. fat pad)
- Type II: Displaced w/ intact posterior periosteum (ant. humeral line is displaced anteriorly rel. to capitellum)
- Type III: Displaced w/ disruption of anterior and posterior periosteum
- No continuity between the proximal and distal fracture fragments
- Direction of displacement is important in predicting neurovascular injury
Treatment
- Type I
- Immobilize using a posterior splint and sling (extend from wrist to axilla)
- Refer to ortho within 1 week
- Type II & III
- Orthopedic consultation regarding closed versus open reduction w/ percutaneous pinning
- Admit
Complications
Vascular
- Absenst radial pulse in 10-20% of cases
- Need to rule-out compartment syndrome
- Occurs more commonly when forearm is also fractured
- Ecchymosis over anteromedial aspect of forearm suggests brachial artery injury
- Rare with type I fx
Neurologic
- Median nerve injury
- Weakness of hand flexors
- Loss of two-point sensation on palmar surface of thumb, IF, MF
- Anterior interosseous nerve is branch of median nerve most often affected
- Forearm pain + difficulty making "ok" sign
- Radial nerve injury
- Weakness of wrist extension, hand supination, and thumb extension (thumbs up)
- Altered sensation in dorsal web space between thumb and index finger
- Ulnar nerve injury
- May occur with flexion type fractures
- Weakness of wrist flexion and adduction, finger spread, flexion of pinky DIP
- Altered sensation of ulnar side of ring/pinky
- Majority of nerve injuries are neurpraxias without long-term sequelae
See Also
Source
UpToDate