Mechanism Įxtension type of supracondylar humerus fractures typically result from a fall on to an outstretched hand, usually leading to a forced hyperextension of the elbow. Such malunion can result in cubitus varus deformity. The distal humerus grows slowly post fracture (only contributes 10 to 20% of the longitudinal growth of the humerus), therefore, there is a high rate of malunion if the supracondylar fracture is not corrected appropriately. Therefore, early surgical reduction is indicated to prevent this type of complication. Swelling and vascular injury following the fracture can lead to the development of the compartment syndrome which leads to long-term complication of Volkmann's contracture (fixed flexion of the elbow, pronation of the forearm, flexion at the wrist, and joint extension of the metacarpophalangeal joint ). Ī puckered, dimple, or an ecchymosis of the skin just anterior to the distal humerus is a sign of difficult reduction because the proximal fragment may have already penetrated the brachialis muscle and the subcutaneous layer of the skin. Ulnar nerve is most commonly injured in the flexion type of injury because it crosses the elbow below the medial epidcondyle of the humerus. This is because the proximal fragment will be displaced antero-laterally. Radial nerve would be injured if the distal humerus is displaced postero-medially. This is evidenced by the weakness of the hand with a weak "OK" sign on physical examination (Unable to do an "OK" sign instead a pincer grasp is performed). Anterior interosseus branch of the median nerve most often injured in postero-lateral displacement of the distal humerus as the proximal fragment is displaced antero-medially. Doppler ultrasonography should be performed to ascertain blood flow of the affected limb if the distal pulses are not palpable. Clinical parameters such as temperature of the limb extremities (warm or cold), capillary refilling time, oxygen saturation of the affected limb, presence of distal pulses (radial and ulnar pulses), assessment of peripheral nerves (radial, median, and ulnar nerves), and any wounds which would indicate open fracture. It is important to check for viability of the affected limb post trauma. This can lead to loss of muscle function. Late onset of pain (hours after injury) could be due to muscle ischaemia (reduced oxygen supply). doi: 10.1007/s1183-1.A child will complain of pain and swelling over the elbow immediately post trauma with loss of function of affected upper limb. Surgical approaches for open reduction and pinning in severely displaced supracondylar humerus fractures in children: a systematic review. The Journal of Bone & Joint Surgery-American Volume. Supracondylar humeral fractures in children. The treatment of displaced supracondylar humerus fractures: evidence-based guideline. Operative management of type III extension supracondylar fractures in children. Kazimoglu C., Çetin M., Şener M., Aguş H., Kalanderer Ö. Prospective analysis of a new minimally invasive technique for paediatric Gartland type III supracondylar fracture of the humerus. (2) The incidence of vascular and nerve complications positively correlates with the progression of fracture according to Gartland classification. (1) In children with supracondylar fracture the most often injured nerve is median nerve. Symptoms of vascular injury occurred in 7.7% children with displaced fracture (17 children). The total nerve function returned after average of 122 days (0-220 days after surgery). The most injured nerve was median nerve this complication occurred in 15 patients (68.18%). Nerve damage was found in 10% of patients with displaced fracture (22 children). Acute neurovascular complications occurred in 16.81% of patients with displaced supracondylar fracture (37 children). The group consisted of 143 males and 77 females. 220 children hospitalized in the Pediatric Trauma-Orthopedic Department in the years 2004-2014. Analysis of early vascular and nerve complications of supracondylar humerus fractures in children.
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