UMEM Educational Pearls

Category: Pediatrics

Title: Supracondylar fractures in children (submitted by Mike Santiago, MD)

Keywords: orthopedics, fracture, reduction, elbow (PubMed Search)

Posted: 6/15/2012 by Mimi Lu, MD
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Definition: Fracture of the humerus just proximal to the epicondyles.

-Classification of fracture based on mechanism:
  • Extension type (majority >80%; distal fx segment displaced posteriorly)
  • Flexion type (distal fx segment displaced anteriorly)
-Assessment should be made for neurovascular injuries.
  • Any diminished pulsations or capillary refill should cause concern for vascular compromise (arterial compression, tear, or compartment syndrome).
  • Place a continuous pulse oximetry probe on the affected hand to monitor bloodflow.
  • The radial, median, or ulnar nerves may be affected and should be assessed.
-Look for accompanying fractures of the forearm and wrist and xray those areas if suspected.
-Nondisplaced fractures may follow up with orthopedics within 1 week after posterior long arm splinting (elbow at 90 degrees & forearm in neutral position)
-Displaced fractures require prompt pediatric orthopedic consultation for closed reduction in OR vs operative repair.
-Obtain emergent orthopedic consultation for compartment syndrome, neurovascular compromise, or open fracture.
-Partial reductions in ED likely just increase soft tissue swelling and delay definitive reduction and should be reserved for rare cases of vascular compromise.


References:
Wheeless, CR.  Pediatric Supracondylar Fractures of the Humerus.  Wheeless’ Textbook of Orthopedics.  [Accessed online 4/22/12.] http://www.wheelessonline.com/ortho/pediatric_supracondylar_fractures_of_the_humerus
Ryan, LM.  Evaluation and management of supracondylar fractures in children.  UpToDate.  [Accessed 4/22/2012].  http://www.uptodate.com/contents/evaluation-and-management-of-supracondylar-fractures-in-children