A prospective multicentre cohort study the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Lateral and ap view of two year old girl with gartland type ii supracondylar fracture. Neer classification of proximal humeral fractures radiology. While some injuries might be humerus shaft fractures, a fracture just above these epicondyles is called a supracondylar fracture of the humerus. Fractures of the proximal humerus are common, accounting for 5% of all fractures. Supracondylar fractures of the humerus comprise 17% of all childhood fractures with a peak age incidence of approximately 6 years. The most commonly proposed mechanism is an excessive torque during the cocking and acceleration phases of the throwing motion. Supracondylar fracture pediatric pediatrics orthobullets.
The most common mechanism for these fractures is a fall on the outstretched hand from a standing height. Proximal means it is the end of the bone that is closest to the body. Overuse can cause stress fractures, which are very small cracks in the bone. The annual rate of children who present with supracondylar fractures.
The supracondylar humerus fracture malreduction involving fracture extension and internal rotation cause changes in the elbow carrying angle and also problems in the elbow workspace 1. Patients with supracondylar fractures will often have prolonged period months of inability to fully extend their elbow. The elbow may appear angulated and the upper extremity shortened. Diagnosis and careful management of the fracture and arterial repair is crucial. The rate of open reduction for fractures with a flexiontype injury pattern and for such fractures with and without ulnar nerve injury at presentation was assessed. If the broken bone punctures the skin, it is called an open or compound fracture. There may be a decreased ability to move the arm and the person may present holding their elbow. Fractures commonly happen because of car accidents, falls, or sports injuries. It has two thickened projections where it joins the elbow called epicondyles. Rehabilitation guidelines for proximal humerus fracture nonoperative 2 p a g e phase ii continued precautions dc sling x 3 weeks if cleared by md aarom to 90 degrees forward flexion and 40 degrees er suggested therapeutic exercises arom cervical, elbow, wrist and hand pendelums gripping exercises scapular pnf progress to full. Large studies have shown that supracondylar fractures occur with nearly. Proximal humerus fracture classifications shoulderdoc by. Displaced supracondylar fractures of the humerus associated with distal fractures of the forearm bones are best treated by closed.
Supracondylar fractures are the most common fracture of the elbow in children. The gartland classification is a commonly used system for evaluation and treatment of supracondylar humerus fractures in children. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Apr 16, 2017 what is a supracondylar fracture of the humerus. Supracondylar and lateral condyle fractures of the humerus in. It has good interobserver and intraobserver reliability and type iii injuries are commonly associated with neurovascular injuries, where there should be heightened awareness. There is an intervening thin area of bone connecting the olecranon fossa and coronoid fossa, which is the location of most supracondylar humerus fractures.
Other causes are low bone density and osteoporosis, which cause weakening of the bones. This retrospective study compares the longterm results of the treatment of 5 children with displaced extensiontype supracondylar fractures of the humerus using 3 different methods. Appointments begin physical therapy at 1 week post op, 2 xweek follow up with md 1014 days post op. Around the world, this type of fracture remains a major challenge for treating surgeons. The proximal humerus is important because it forms half of the shoulder joint. Figure 1510 a and b, simple realignment of an ischemic limb may reduce the tension on the brachial artery and restore the distal circulation.
Mots cles fracture supracondylienne humerus enfant. While majority of isolated displaced supracondylar fractures of the humerus are managed with closed reduction and percutaneous fixation, the treatment of a supracondylar fracture in the presence. Pediatric supracondylar fractures of the distal humerus. So how does the humerus fracture from throwing a baseball. Elle est basee sur limportance du deplacement du fragment distal. Gartlands classification of supracondylar fracture of humerus. Show full abstract reduction and percutaneous pin fixation of the humeral fracture and a belowelbow plaster backslab. A patients guide to adult proximal humerus shoulder fractures compliments of.
The specific etiology of supracondylar humerus fractures in children is not well known. This does not cause functional disability and should not be treated with physiotherapy. The humeral shaft is the middle portion of the bone with the shoulder joint at the top end and the elbow joint at the bottom. The shoulder joint is essentially a ball and socket joint. Closed reduction and percutaneous pinning of displaced supracondylar humerus fractures in children. Twenty synthetic humeri were sectioned in the mid olecranon fossa to simulate a supracondylar humerus fracture. Arterial damage accompanying supracondylar fractures of the. Overview supracondylar fractures are one of the most common traumatic fractures see in children and most commonly occur in children 57 years of age from a fall on an outstretched hand treatment is usually closed reduction and percutanous pinning crpp, with the urgency depending on whether the hand remains perfused or not. Gartland classification modified type 1 nondisplaced. F ractures of the humeral shaft account for approximately 3% of all fractures.
Management of supracondylar fractures of the humerus in. Fracture coude enfant, fracture supracondylienne, epicondyle, condyle humeral, traumatisme. Humeral shaft fractures hsfs are one of the most common injuries in trauma centers. Proximal humerus fractures explanation of diagnosis andor procedures shoulder anatomy the humerus is the long bone that connects the shoulder to the elbow. Posteromedial displacement of the distal fragment is the most frequent. Traitement differe des fractures supracondyliennes du. It has been estimated that they account for approximately 65% of all fractures and dislocations in children.
Adult proximal humerus shoulder fractures an atomy the proximal humerus is the top portion of the humerus upper arm bone. Type ii pediatric supracondylar humerus fracture management. Pdf supracondylar fracture of the humerus in children. Extraarticular fractures of the distal humerus malunions of the distal humerus nonunions of the distal humerus features indications. The treatment of displaced supracondylar fractures of the. Appointments no pt for 3 weeks, unless otherwise specified by md rehabilitation goals modalities to control pain and swelling protect fracture site maintain rom in surrounding joints prevent deconditioning.
K, 7 years old, had sustained a supracondylar fracture of the left elbow after the fall on the left hand with elbow extended. It is the most common fracture of the humerus, as well as the most common fracture at the shoulder girdle. Supracondylar fracture of the humerus emergency department. Proximal humeral fracture postsurgical rehabilitation protocol open reduction internal fixation general principles. The aim of this study was to determine the prevalence and outcome of supracondylar fractures. A humerus fracture is a break of the humerus bone in the upper arm. Understanding the anatomy, radiographic findings, complications, and management options associated with this fracture allow physicians to limit the morbidity associated with this injury. Supracondylar fractures of the humerus in children are the result of trauma to the elbow, most often a fall from height or related to sports or leisure activities. Sep 06, 2017 data recorded included age, mechanism of injury, fracture type open or closed, fracture pattern flexiontype or extensiontype, concomitant skeletal injury, neurovascular injury, treatment, and surgeon. Plate fixation for management of humerus fractures. Supracondylar fractures of the humerus sch are the most common fractures about the elbow in children that require operative stabilization. Fracture shaft of ulnar, together with disruption of the proximal radioulnar joint and dislocation of radiocapitallar joint fracture of base of the first metacarpal bone salterharris fracture fracture that involves the epiphyseal plate or growth plate of a bone type i.
I opted to go home later to talk with my doctor first and ended up going to kern medical center fresh fracture. These fractures tend to occur in older patients who are osteoporotic. The incidence of proximal humeral fractures lies between 105 and 342 per 100 000 persons per year. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. Welcome to the world of supracondylar fractures fracture of children not scary but spectacular it is a great teacher teaches you the values of basics in orthopedics it is kind and forgiving if you make a mistake cubitus varus, it forgives you no functional impairment but will not allow you to forget cosmetic disability in its. An analysis of varying pin size, number and lateral starting points has not previously been performed. Complications of supracondylar fractures of the elbow.
After age 15, it is a rare fracture, distal humeral fractures tending to be of a more adult pattern, frequently involving the articular surfaces and extending proximally into the diaphysis. A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. The full text of this article is available in pdf format. Return to normal function and motion may require 3 to 4 months overall goals. These fractures are the result of trauma to the elbow, most often from a fall from height monkey bars are. Fracture that involves the epiphyseal plate or growth plate of a bone type i. An algorithm for the treatment of supracondylar humerus fractures associated with forearm and hand ischemia is represented in figure 1511. Supracondylar humeral fracture radiology reference article. This typically happens after a fall on the affected side, followed by pain in that arm or shoulder. Anterior to the supracondylar area of the distal humerus is the median nerve. The treatment of proximal humeral fracture in adults. Humeral shaft fracture pediatric pediatrics orthobullets. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles.
Adult humerus shaft fractures an atomy the humerus is the long, tubular bone that makes up the upper arm. Rehabilitation goals protect repair minimize pain and swelling maintain rom of surrounding joints. Prise en charge des fractures supracondyliennes en extension. Pdf supracondylar fractures of the humerus in children. However, good surgical outcomes can be achieved with proper patient selection. Fractures of the humerus in young adults are typically the result of highenergy direct trauma. Supracondylar humeral fracture radiology reference. Supracondylar fractures of the humerus are a common pediatric elbow injury that can be associated with neurovascular complications and skeletal deformity. Biomechanical analysis of pin placement for pediatric. The humerus is the bone that makes up the upper portion of the arm.
Associated injuries in adjacent joints may be noted. Early home physical therapy for my humerus fracture youtube. Proximal humerus fracture book twin cities orthopedics. Supracondylar humerus fractures are the most common elbow fracture in children and have the highest complication rate for elbow fractures in this age group. Considering the possible complications involved including nerve deficit and compartment syndrome, documentation is crucial to good patient care. A proximal humerus fracture is a break in the arm bone near the shoulder, or a broken shoulder. She is neurovascularly intact and the skin shows no evidence of open wounds. Pediatric humeral shaft fractures are usually traumatic in nature, although nonaccidental trauma and pathologic lesions can not be overlooked. Closed reduction and percutaneous fixation was superior with excellent and good results in 87% and had the lowest incidence of poor results 8%.
Early home physical therapy for my humerus fracture. The terminology and factors which influence the classification are essential for the utility of radiological reports of proximal humeral fractures. Supracondylar humerus fractures pediatric orthopaedic. On lateral view the anterior humeral line is anterior to the middle of capitellum. Extensiontype fractures represent 97% to 99% of cases. Fracture supracondylar humerus is one of the most common fractures encountered in pediatric age group at all levels both rural and urban. Review article management of humeral shaft fractures. Supracondylar fractures of the humerus are the most frequent fractures of the paediatric elbow, with a peak incidence at the ages of five to eight years. Leur diagnostic dans notre contexte est tres souvent tardif en raison du massage traditionnel initial. Incidence age is the key factor in the incidence of supracondylar fractures, occurring almost exclusively in the immature. The neer classification of proximal humeral fractures is probably the most frequently used system along with the ao classification of proximal humeral fractures. The upper part of the humerus forms part of the shoulder joint and the lower part of the bone helps form part of the elbow joint.
While nondisplaced fractures can be managed conservatively. The anatomically shaped and angular stable fixation system for extraarticular fractures of the distal humerus. Jan 15, 2012 arterial damage is sometimes associated with supracondylar fractures of the humerus. They are more common in women than men, and occur more often in older adults. C fractures, provided that the domed head fragment is large enough and that it is not itself fractured. Supracondylar humerus fracture what is a supracondylar fracture. Open reduction and wire fixation, and closed reduction with a. In the proximal forearm, the anterior interosseous branch separates to innervate the flexor profundus to the index finger and the flexor pollicis longus and then terminates with the innervation of the pronator quadratus. While the treatment of proximal humerus fractures remains controversial, certain fractures benefit from plate fixation such as fracturedislocations and headsplit fractures. Increase rom while protecting the fracture site you can be slightly more.
On the ap view, fracture lines can be seen through the metaphyseal bone of the distal humerus on either side of the olecranon fossa. Conclusions iatrogenic or fracture related nerve injury in a supracondylar humerus fracture is a benign condition which may be resolved spontaneously and observation appears to be a good and valuable method for treatment of this complication. Pdf iatrogenic or fracturerelated nerve injuries in. Classification no universally accepted system for humeral shaft fractures anatomical proximal shaft, middle shaft, or distal shaft. Bony healing occurs usually within 6 to 8 weeks in adults 2. Sickkids parent information sheet supracondylar humerus fracture without displacement. These fractures are more commonly seen in boys 4 these injuries are almost always due to accidental trauma, such as falling from a moderate height bedmonkeybars 4. Humerus, fracture supra condyliennes, enfant, traitement.
Supracondylar humeral fractures, often simply referred to as supracondylar fractures, are a classic pediatric injury which require vigilance as imaging findings can be subtle. Diagnosis and management about in brief in brief has been developed by pediatric orthopedic specialists at gillette childrens specialty healthcare as a resource for primary care providers. She was admitted in local hospital where the clinical examination and x ray were made and they confirmed the. Distal humerus anatomy medial epicondyle proximal to trochlea lateral epicondyle proximal to capitellum radial fossa accommodates margin of radial head during flexion coronoid fossa accepts coronoid process of ulna during flexion. A patients guide to adult humerus shaft fractures compliments of. All supracondylar humerus fractures treated at childrens hospital and health center, san diego chsd over. A patient s guide to adult proximal humerus shoulder. If you have comments or questions, please contact jason kelecic, d.
Throwers fracture of the humerus mdedge emergency medicine. The average age of people who sustain a proximal humerus fracture is 6366 years. Multiple studies have shown their peak incidence to be among 5 to 6yearolds, with an age range that reaches from 1 to 14 years712. The expert proximal humeral nail is inserted antegrade into the proximal humeral shaft and can be used universally for either the left or right humerus. Minimally displaced one part fractures no segment displaced 1cm or angulated 45 deg two part fracture of anatomical neck, articular segment displaced high risk of avn two part fracture of the surgical neck with shaft displacement. Simple supracondylar fractures are typically seen in younger children, and are uncommon in adults. Type ii pediatric supracondylar humerus fracture management and outcomes. Aug 23, 2019 the clinical presentation of a supracondylar humerus fracture schf is that of a painful swollen elbow that the patient is hesitant to move. When the normal elbow is extended in the anatomic position, the forearm has valgus angulation relative to the humerus known as the carrying angle with. Anatomy of the distal humerus includes medial and lateral columns. Treatment is almost always immobilization due to the high remodeling potential of the pediatric humerus. Complications may include injury to an artery or nerve, and compartment syndrome the cause of a humerus fracture is usually physical trauma such as a fall. Most common elbow fractures seen in children 5 to 6yrs boys vs gals 3. Epidemiology simple supracondylar fractures are typically seen in yo.
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