Management of Supracondylar Humerus Fractures in Children: Current Concepts

Abzug, Joshua M.; Herman, Martin J.

doi:10.5435/jaaos-20-02-069

Cited by 109 publications

(124 citation statements)

References 28 publications

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“…Type I fractures (nondisplaced) are managed nonsurgically, but most displaced injuries (types III and IV) require surgical intervention [3]. Angulated fracture (type II) treatment is controversial and dependent on the amount of angulation; some advocate for closed treatment and others for surgical treatment.…”

Section: Introductionmentioning

confidence: 99%

Multicenter Study of Pin Site Infections and Skin Complications Following Pinning of Pediatric Supracondylar Humerus Fractures

Combs¹,

Frick²,

Kiebzak³

2016

Cureus

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Introduction: Pediatric supracondylar humerus fractures are the most common elbow fractures in pediatric patients. Surgical fixation using pins is the primary treatment for displaced fractures. Pin site infections may follow supracondylar humerus fracture fixation; the previously reported incidence rate in the literature is 2.34%, but there is significant variability in reported incidence rates of pin site infection. This study aims to define the incidence rate and determine pre-, peri-, and postoperative factors that may contribute to pin site infection following operative reduction, pinning, and casting.Methods: A retrospective chart analysis was performed over a one-year period on patients that developed pin site infection. A cast care form was added to Nemours’ electronic medical records (EMR) system (Epic Systems Corp., Verona, WI) to identify pin site infections for retrospective review. The cast care form noted any inflamed or infected pins. Patients with inflamed or infected pin sites underwent a detailed chart review. Preoperative antibiotic use, number and size of pins used, method of postoperative immobilization, pin dressings, whether postoperative immobilization was changed prior to pin removal, and length of time pins were in place was recorded.Results: A total of 369 patients underwent operative reduction, pinning, and casting. Three patients developed a pin site infection. The pin site infection incidence rate was 3/369=0.81%. Descriptive statistics were reported for the three patients that developed pin site infections and three patients that developed pin site complications.Conclusion: Pin site infection development is low. Factors that may contribute to the development of pin site infection include preoperative antibiotic use, length of time pins are left in, and changing the cast prior to pin removal.

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Section: Introductionmentioning

confidence: 99%

Multicenter Study of Pin Site Infections and Skin Complications Following Pinning of Pediatric Supracondylar Humerus Fractures

Combs¹,

Frick²,

Kiebzak³

2016

Cureus

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“…Kao i u našem istraživanju, učestalost suprakondilarnih preloma lakta u pogledu pola pokazuje da su ovi prelomi dva puta češći kod dečaka nego kod devojčica (6,9,15). To se može povezati sa uzrastom pacijenata i načinom povređivanja, gde su dečaci u tom uzrastu skloniji nepažljivim situacijama u igri.…”

Section: Diskusijaunclassified

Supracondylar fractures of humerus at children

Božić¹,

Ćirić²,

Mikic³

et al. 2018

Sestrinska reč

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od dece uzrasta ispod 15 godina, u najčešće nenamerne povrede spadaju različiti prelomi gornjih i donjih ekstremiteta, a na šestom mestu sa učestalošću od 5,2% nalaze se frakture humerusa (1). Prelomi lakta čine 7-9% svih preloma u dečijem uzrastu, dok suprakondilarni prelomi humerusa predstavljaju jednu od tipičnih povreda dečjeg uzrasta koji nastaju kao posledica pada na ispruženu ruku i čine oko 60% do 75% svih fraktura donjeg okrajka humerusa u dece (2, 3-8). U odnosu na stranu češće se javljaju na levom laktu 58%, u odnosu na desni lakat 42%, zbog funkcije odbrane koju leva ruka vrši pri padu, dok se desna ruka više upotrebljava za hvatanje, i češće se javljaju kod dečaka nego kod devojčica (2, 9). Kliničku sliku suprakondilarnog preloma humerusa karakteriše jak bol u predelu lakta koji se pojačava pri svakom pokretu. Pored toga, prisutni su još i otok i hematom, osetljivost oba kondila i klasičan deformitet u obliku slova »S« u predelu zgloba lakta (10). Prelomi mogu biti zatvoreni i otvoreni. Pri zatvorenim prelomima integritet kože nije prekinut, dok pri otvorenim prelomima postoji

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“…Extension type supracondylar fractures are the most frequent (99%) fracture type [1]. The mechanism of injury is secondary to a fall onto an outstretched hand [2][3]. The remaining fractures are classified as flexion type supracondylar fractures and are the result of a direct blow to the flexed elbow [2][3].…”

Section: Introductionmentioning

confidence: 99%

“…The mechanism of injury is secondary to a fall onto an outstretched hand [2][3]. The remaining fractures are classified as flexion type supracondylar fractures and are the result of a direct blow to the flexed elbow [2][3]. Extension type supracondylar fractures are further classified into three types, according to the Gartland classification [4].…”

Section: Introductionmentioning

confidence: 99%

“…Gartland III-type fractures are completely displaced fractures, without contact of both the anterior and posterior cortices of the distal humeral metaphysis. Provided that adequate reduction has been obtained, Gartland I and II-type fractures are usually stabilized by nonsurgical means while Gartland III fractures are almost routinely treated by closed reduction and percutaneous pinning (CRPP) [2][3][4]. In 20% of the cases, open reduction may be necessary to obtain an acceptable result [1].…”

Section: Introductionmentioning

confidence: 99%

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Role of the Posterior Fat Pad Sign in Treating Displaced Extension Type Supracondylar Fractures of the Pediatric Elbow Using the Blount Method

Samelis

Papagrigorakis²,

Ellinas

2019

Cureus

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The posterior fat pad sign (PFPS) on the lateral elbow X-ray is useful in the diagnosis of a suspected nondisplaced fracture about the elbow after a subtle injury. However, the presence of a PFPS hallmarks a continuous posterior periosteum-posterior capsule of the distal humerus. This anatomic structure is crucial for the stable anatomic reduction of a displaced extension type supracondylar fracture. Subsequently, the presence of a PFPS may predict the successful nonoperative treatment of a Gartland III-type fracture by means of the Blount method, implying less implant-related morbidity and less intraoperative radiation exposure for the patient and surgeon. Furthermore, it is concluded that a PFPS-positive displaced extension type supracondylar fracture is definitively classified as a Gartland III and not a Gartland IV-type fracture. A retrospective study of 75 displaced extension type supracondylar elbow fractures was performed. All fractures had an initial attempt at a closed reduction under general anesthesia. A stable reduction in 120 degrees of elbow flexion without vascular compromise of the affected limb was achieved in 45 fractures, which were splinted in this position. In the remaining 30 cases, fracture reduction was either inadequate or was achieved with excess elbow flexion, which impaired distal blood flow. These fractures were pinned percutaneously and splinted in 90 degrees of elbow flexion. The two treatment groups were retrospectively compared for the presence of a PFPS. The displaced extension type supracondylar fractures, which were treated successfully by the Blount method, had a statistically significant higher prevalence (chi-square-Yates =4.91, p<0.05) of a positive PFPS (28/45 patients, 62.22%) compared to the fractures treated by closed reduction and percutaneous pinning (10/30, 33.33%). No vascular complications were observed. The long-term outcome did not differ between groups.

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Management of Supracondylar Humerus Fractures in Children: Current Concepts

Cited by 109 publications

References 28 publications

Multicenter Study of Pin Site Infections and Skin Complications Following Pinning of Pediatric Supracondylar Humerus Fractures

Multicenter Study of Pin Site Infections and Skin Complications Following Pinning of Pediatric Supracondylar Humerus Fractures

Supracondylar fractures of humerus at children

Role of the Posterior Fat Pad Sign in Treating Displaced Extension Type Supracondylar Fractures of the Pediatric Elbow Using the Blount Method

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