Diferencia entre revisiones de «Supracondylar fracture»
(Created page with "==Mechanism of Injury== * Extension-type fractures * 95% of suprcondylar fractures * Due to FOOSH * Flexion-type fractures * 5% of supracondylar fractures * Due to direct traum...") |
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==Mechanism of Injury== | ==Mechanism of Injury== | ||
* Extension-type fractures | * Extension-type fractures | ||
* 95% of suprcondylar fractures | ** 95% of suprcondylar fractures | ||
* Due to FOOSH | ** Due to FOOSH | ||
* Flexion-type fractures | * Flexion-type fractures | ||
* 5% of supracondylar fractures | ** 5% of supracondylar fractures | ||
* Due to direct trauma to posterior aspect of flexed elbow | ** Due to direct trauma to posterior aspect of flexed elbow | ||
==Physical Findings== | ==Physical Findings== | ||
* Do not encourage active/passive elbow movement until displaced fx has been ruled-out | |||
* Do not encourage active/passive elbow movement until displaced fx has been ruled-out | |||
* Pain, swelling, very limited to no range of motion at the elbow | * Pain, swelling, very limited to no range of motion at the elbow | ||
* Nondisplaced fx may have limited swelling, but child will refuse to move arm | * Nondisplaced fx may have limited swelling, but child will refuse to move arm | ||
| Línea 19: | Línea 14: | ||
* If evidence of S-shape configuration or skin dimpling, spint before xray | * If evidence of S-shape configuration or skin dimpling, spint before xray | ||
* Forearm/wrist injuries | * Forearm/wrist injuries | ||
* Occur frequently enough with supracondylar fx that imaging should be performed | ** Occur frequently enough with supracondylar fx that imaging should be performed | ||
==Gartland Classification== | ==Gartland Classification== | ||
Type I: Nondisplaced with evidence of elbow effusion (ant. sail and/or post. fat pad) | Type I: Nondisplaced with evidence of elbow effusion (ant. sail and/or post. fat pad) | ||
| Línea 33: | Línea 25: | ||
* No continuity between the proximal and distal fracture fragments | * No continuity between the proximal and distal fracture fragments | ||
* Direction of displacement is important in predicting neurovascular injury | * 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=== | |||
* 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=== | |||
* 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== | ||
[[Elbow (Fracture)]] | |||
[[Elbow (Minor)]] | |||
[[Elbow Fracture (Peds)]] | |||
[[Elbow Xray Peds]] | |||
==Source== | |||
UpToDate | |||
[[Category:Peds]] | [[Category:Peds]] | ||
[[Category:Ortho]] | |||
Revisión del 04:11 9 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
Physical Findings
- Do not encourage active/passive elbow movement until displaced fx has been ruled-out
- Pain, swelling, very limited to no range of motion at the elbow
- 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, spint before xray
- Forearm/wrist injuries
- Occur frequently enough with supracondylar fx that imaging should be performed
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