Supracondylar fracture

Revisión del 23:23 29 oct 2010 de Robot (discusión | contribs.) (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

  • 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

Ortho: Elbow (Fracture)

Ortho: Elbow (Minor)

Peds: Elbow Fracture (Peds)

Rads: Elbow Xray Peds


Source: UpToDate

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