CBD

At ER

Supracondylar Fracture of Humerus in children

For 5 th year Medical student

.. Songkhla Hospital

Overview

Epidemiology Anatomy Mechanism of injury Clinical evaluation Radiology Classification Treatment Complication

Epidemiology

These comprise 55% to 75% of all elbow fractures The male-to-female ratio is 3:2 The peak incidence is from 5 to 8 years The left, or nondominant side, is most frequently injured

Anatomy : Bone

Development : ossification center

Development : C R I T O E

Ossification center

Ossification center

Oscification Center Fusion

Anatomy:
Blood supply

Anatomy: Blood supply

Anatomy : Nerve

Anatomy: Nerve

Anatomy : Ligament

Anatomy : Fat pad

Anterior fat pad

Posterior fat pad

Mechanism of Injury

Indirect : This is most commonly a result of a fall onto an outstretched upper extremity Direct : Direct trauma to the elbow may occur from a fall onto a flexed elbow or from an object striking the elbow

Indirect force

Text
Direct force

Physical Examination

General examination Vascular examination Nerve examination

Clinical evaluation

Pucker or Dimpling sign

Radiology

Plain film Standard AP and lateral views

Supplementary film - Lateral oblique - Medial oblique

Radiology Evaluation : A B C S

A : Adequacy Alignment and Angle B : Bone C : Cartilarge S : Soft tissie

Alignment and angle : Standard AP

view

Alignment and angle : Standard

lateral view

A: The teardrop of the distal humerus : well defined B: Diaphyseal-Condylar Angle : 35-40 degree C: The anterior humeral line : through middle third of the ossification center of the capitellum D: The coronoid line : touch the anterior portion of the lateral condyle

Anterior humeral line

Radiocapitellar line

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Radiocapitellar line in all elbow movement

Posterior margin of coroniod fossa

Anterior margin of olecranon fossa

30-45

Tear drop

Diaphyseal condyla angle

Bones

Distal humerus Radius Ulnar Oscification centers in children

Cartilarge

Examine joint space on AP and lateral view.The pediatric elbow is largely cartilarge

Soft tissue

Anterior fat pad Posterior fat pad Supinator fat stripe

Fat Pad Sign

Classification of Supracondylar Fractures ( Gartland Classification )

Extension type : 98% of supracondylar humerus

fractures in children

Type I Type II Type III Type IV

Nondisplaced Displaced with intact posterior cortex Complete Displaced (no cortical contact ) Postelomedial/Postelolateral Multiple-directional instability

Type I Nondisplaced

Type II Displaced with intact posterior cortex

Type III Complete Displaced (no cortical

contact)

Classification of Supracondylar Fractures ( Gartland Classification )

Flexion type : 2% of supracondylar humerus

fractures in children

Type I Type II Type III Type IV

Nondisplaced Displaced with intact anterior cortex Complete displacement : usually anterolateral Multiple-directional instability

Treatment

Type I: Simple immobilization in long arm cast or slab for 3 weeks

Retention

Treatment

Type II: Manipulation and immobilization in long arm cast in hyperflexion

Reduction

Type III: Close reduction with percutaneous

pinning

Retention

Olecranon Traction

Olecranon Traction
Indication Severe comminution Lack of anesthesia Medical condition problem Lack of experience Sx Temporary for reduction and decrease swelling

Open reduction
Indication Closed reduction fail Neurovascular injury Open fracture

Complications
Acute

Neurovascular injury Compartment syndrome

Late
Physeal injury Cubitus varus more common than Cubitus vagus

The carrying angle is the angle defined by the border of the fully supinated forearm and the long axis of the humerus when the elbow is fully

extended

Example

What type of this fracture ?

What type of this fracture ?

What type of this fracture ?

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Do you have any question ?

Physeal Injuries: Salter-Harris

II

III

IV