Supracondylar fx for years 5 PPT.ppt

8/14/2019 Supracondylar fx for years 5 PPT.ppt

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CBD

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At ER
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Supracondylar Fracture of

Humerus in children

..

Songkhla Hospital

For 5 thyear Medical

student


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Overview

Epidemiology

Anatomy

Mechanism of injury Clinical evaluation

Radiology

Classification Treatment

Complication


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Epidemiology

These comprise 55%to 75%of all elbowfractures

The male-to-female ratio is 3:2

The peak incidence is from 5to8years

The left, or nondominant side, is mostfrequently injured


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Anatomy : Bone


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Development : ossification center


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Development : C R I T O E


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Ossification center


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Ossification center


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Oscification Center Fusion


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Anatomy:Blood supply


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Anatomy: Blood

supply


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Anatomy : Nerve


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Anatomy:Nerve


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Anatomy : Ligament


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Anatomy : Fat pad

Anterior fat pad

Posterior fat pad


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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


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Indirect force

Direct force

Text


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Physical Examination

General examination

Vascular examination

Nerve examination


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Clinical evaluation
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Pucker or Dimpling sign


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Radiology

Plain film

Standard AP and lateral views

Supplementary film

- Lateral oblique

- Medial oblique


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Radiology Evaluation :A B C S

A : Adequacy

Alignment and Angle

B : Bone

C: Cartilarge

S: Soft tissie


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Alignment and angle : Standard APview


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Alignment and angle : Standardlateral 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


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Anterior humeral line Radiocapitellar line


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3131


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Radiocapitellar line in all elbow movement


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Diaphyseal condyla angle

30-45

Posterior margin of coroniod fossa

Anterior margin of olecranon fossa

Tear drop


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Bones

Distal humerus

Radius

Ulnar

Oscification centers in children


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Cartilarge

Examine joint space on AP and lateral

view.The pediatric elbow is largely

cartilarge


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Soft tissue

Anterior fat pad

Posterior fat pad

Supinator fat stripe


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Fat Pad Sign


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Classification of Supracondylar

Fractures ( Gartland Classification )

Extension type: 98% of supracondylar humerusfractures in children

Type I Nondisplaced

Type II Displaced with intact posterior cortex

Type III Complete Displaced (no cortical contact)Postelomedial/Postelolateral

Type IV Multiple-directional instability


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Type I Nondisplaced


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Type IIDisplaced with

intact posterior cortex


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Type IIIComplete

Displaced (no cortical

contact)


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Treatment

Type I:Simple immobilization in long arm cast

or slab for 3 weeks

Retention


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Treatment

Type II:Manipulation and immobilization

in long arm cast in hyperflexion

Reduction


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Type III:Close reduction with percutaneouspinning

Retention


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Olecranon Traction


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Open reduction

Indication

Closed reduction fail

Neurovascular injury

Open fracture


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Complications

Acute

Neurovascular injury

Compartment syndrome

Late

Physeal injury Cubitusvarus more common than

Cubitus vagus


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The carrying angle is the

angle defined by the

border of the fully

supinated forearm and thelong axis of the humerus

when the elbow is fully

extended


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Example


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What type of this fracture ?


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5555


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5656


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Do you have any question ?
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Physeal Injuries: Salter-Harris

I II III IV V

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Supracondylar fx for years 5 PPT.ppt