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SUPRACONDYLAR FRACTURE IN

CHILDREN

Adnal Khemal Pasha Husein Putra


20134011130
INTRODUCTION

• A fracture is a break in the structural continuity of bone.


• It may be no more than a crack, a crumpling or a splintering of the cortex; more
often the break is complete and the bone fragments are displaced.
• If the overlying skin remains intact it is a closed (or simple) fracture; if the skin
or one of the body cavities is breached it is an open (or compound) fracture →
liable to contamination and infection

1. Solomon, L., Warwick, D., & Nayagam, S. (2010). Apley's System Of Orthopaedic and Fractures; Ninth Edition. London: HodderArnold.
Fractures result from:
1) Injury;
2) Repetitive stress;or
3) Abnormal weakening of the bone (a ‘pathological’fracture).

1. Solomon, L., Warwick, D., & Nayagam, S. (2010). Apley's System Of Orthopaedic and Fractures; Ninth Edition. London: HodderArnold.
TYPES OF FRACTURE
COMPLETE FRACTURES
The bone is split into two or more fragments

1. Solomon, L., Warwick, D., & Nayagam, S. (2010). Apley's System Of Orthopaedic and Fractures; Ninth Edition. London: HodderArnold.
TYPES OF FRACTURE
INCOMPLETE FRACTURES
Here the bone is incompletely divided and the periosteum remains in continuity

1. Solomon, L., Warwick, D., & Nayagam, S. (2010). Apley's System Of Orthopaedic and Fractures; Ninth Edition. London: HodderArnold.
OSTEOLOGY

2. Jon C Thompson (2010). Netter’s concise orthopaedic anatomy 2nd Edition.


2. Jon C Thompson (2010). Netter’s concise orthopaedic anatomy 2nd Edition.
MUSCLES

2. Jon C Thompson (2010). Netter’s concise orthopaedic anatomy 2nd Edition.


2. Jon C Thompson (2010). Netter’s concise orthopaedic anatomy 2nd Edition.
NERVES

2. Jon C Thompson (2010). Netter’s concise orthopaedic anatomy 2nd Edition.


ARTERIES

2. Jon C Thompson (2010). Netter’s concise orthopaedic anatomy 2nd Edition.


DEFINITION
• SUPRACONDYLAR HUMERUS (SCH) fractures are the most common
elbow fractures in the pediatric population and make up nearly 18% of all
fractures for children
• The median age at presentation is between 3 and 8 years
• The most common mechanism of injury is that of a hyperextension load on
the elbow from falling onto the outstretched arm
• In most cases, the nondominant arm is affected.

3. Mitchelson AJ, Illingworth KD, Robinson BS, et al. Patient demographics and risk factors in pediatric distal humeral supracondylar fractures. Orthopedics.
2013;36(6):e700ee706.
• The annual incidence of supracondylar fractures has been estimated at 177.3
per 100 000
• Some studies indicate a greater risk in boys, but recent data have evidenced
growing injury rates across both sexes possibly due to increased participation
in sports.
• Patients above the age of 8 years→ most often results from high-energy
traumas
• extension type of fracture in 97–99%, flexion type→ rare

4. Omid R, Choi PD, Skaggs DL. Supracondylar humeral fractures in children. J Bone Joint Surg Am 2008; 90:1121–1132.
5. Houshian S, Mehdi B, Larsen MS. The epidemiology of elbow fracture in children: analysis of 355 fractures, with special reference to supracondylar
humerus fractures. J Orthop Sci 2001; 6:312–315.
2. Jon C Thompson (2010). Netter’s concise orthopaedic anatomy 2nd Edition.
CLASSIFICATION
Gartland Classification (Extension type)

Flexion type (Uncommon)


TheBaumann angle→ can be useful to determine whether a varus/valgus
deformity exists.
It is defined as the angle formed by a line perpendicular to the humeral shaft
and the physeal line of the lateral condyle.
A normal Baumann angle is approximately 720 but it can range from 640 to 810
HISTORY

2. Jon C Thompson (2010). Netter’s concise orthopaedic anatomy 2nd Edition.


PHYSICAL EXAM

2. Jon C Thompson (2010). Netter’s concise orthopaedic anatomy 2nd Edition.


2. Jon C Thompson (2010). Netter’s concise orthopaedic anatomy 2nd Edition.
COMPLICATIONS
• Associated neurological and/or vascular injuries
• Radial nerve injuries are more common with posteromedial displacement.
• Ulnar nerve injuries→most commonly in flexion-type injuries.
• Pulseless→ dopler examination→ surgical exploration of the brachial artery
• If after reduction the patient’s hand remains pulseless and poorly perfused→ will
require vascular surgery→ 25% may develop compartment syndrome
• Late complication: malunion → cubitus varus/gunstock deformity.

6.Choi PD, Melikian R, Skaggs DL. Risk Factors for vascular repair and compartment syndrome in the pulseless supracondylar humerus fracture
in children. J Pediatr Orthop. 2010;30(1):50e56.
7.Skaggs D, Frick S. Upper extremity fractures in children. In:Weinstein SL, Flynn JM, eds. Lovell and Winter’s Pediatric Orthopaedics.7th ed.
Philadelphia, PA: Lippincott Williams & Wilkins;2014: Chapter 33: 1704e1724.
1. Solomon, L., Warwick, D., & Nayagam, S. (2010). Apley's System Of Orthopaedic and Fractures; Ninth Edition. London: HodderArnold.
1. Solomon, L., Warwick, D., & Nayagam, S. (2010). Apley's System Of Orthopaedic and Fractures; Ninth Edition. London: HodderArnold.
TREATMENT
• Type I SCH
fractures can be treated with long arm immobilization for 3 to 4 weeks
• Type II SCH
fractures can be treated with closed reduction and long arm casting in
hyperflexion, or with CRPP
• Type III SCH
fractures should be treated with CRPP

8.Ballal MS, Garg NK, Bass A, Bruce CE. Comparison between collar and cuffs and above elbow back slabs in the initial treatment of
Gartland type I supracondylar humerus fractures. J Pediatr Orthop B.2008;17(2):57e60.
7.Skaggs D, Frick S. Upper extremity fractures in children. In:Weinstein SL, Flynn JM, eds. Lovell and Winter’s Pediatric Orthopaedics.7th ed.
Philadelphia, PA: Lippincott Williams & Wilkins;2014: Chapter 33: 1704e1724.
• AAOS guidelines suggest CRPP as a treatment method for all displaced
SCH fractures
• The guidelines recommend the use of 2 to 3 laterally introduced pins when
performing CRPP
• Two or 3 pins should be introduced from the lateral aspect to avoid injury to
the ulnar nerve.

9.Howard A, Mulpuri K, Abel MF, et al, American Academy of Orthopaedic Surgeons. The treatment of pediatric supracondylar humerus fractures. J Am Acad
Orthop Surg. 2012;20(5):320e327
10.Mulpuri K, Wilkins K. The treatment of displaced supracondylar humerus fractures: evidence-based guideline. J Pediatr Orthop.2012;32
(suppl2):S143eS152.
1. Solomon, L., Warwick, D., & Nayagam, S. (2010). Apley's System Of Orthopaedic and Fractures; Ninth Edition. London: HodderArnold.
THANK YOU

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