Supracondylar Humerus Fractures Flashcards
What is the most common nerve palsy with a SCH in peds?
AIN (can’t make OK-sign)
Radial n. is a close second (inability to extend wrist or digits)
Ulnar n. is seen with flexion deformities
Which type of deformity is most common in SCH fx in peds?
Extension (95-98%)
What are the age of ossification and fusion for the various elbow ossification centers?
Capitellum (appears age 1-2; fuses age 12)
Radial head (appears age 4; fuses age 15)
Internal (medial) epicondyle (appears age 6; fuses age 17)
Trochlea (appears age 8; fuses age 12)
Olecranon (appears age 10; fuses age 15)
External (lateral) epicondyle (appears age 11; fuses age 12)
Which is the last ossification center to appear in the elbow? Fuse?
Appear- Lateral epicondyle
Fuse- Medial epicondyle
What is the classification for SCH fx in peds?
Gartland:
Type I- nondisplaced (beware slight medial comminution)
Type II- displaced; posterior cortex intact
Type III- completely displaced
Type IV- complete periosteal disruption w/ instability in flexion/extension
How is vascular insufficiency defined in SCH fx in peds?
COLD, pale and pulseless hand (~ 5-17%)
warm, pink and pulseless does not qualify
Vascular insufficiency needs urgent reduction ER and pins in OR
What are radiographic signs of SCH fx in peds?
1) Posterior fat pad sign
2) Anterior humeral line is normally in middle of capitellum
3) alteration in Bauman’s angle (normal is 70-75°)
Which SCH pediatric fx can be managed with closed reduction and long arm casting?
1) Type I
2) Type II with following criteria:
humeral line goes through anterior capitellum
no medial comminution
minimal swelling present
typically used for 3-4 weeks and maybe followed for additional time in removable long arm posterior splint
Which SCH pediatric fxs can be treated with closed reduction and pinning in a delayed fashion?
Most Type II w/ moderate displacement, swelling and/or medial comminution and Type III injuries
Can be treated open if cannot get adequate reduction
Which SCH pediatric fxs must be treated with immediate closed reduction and perc pinning?
1) vascular insufficiency
2) “Floating elbow”; if SCH and ipsilateral forearm fx both must be CRPP to prevent compartment syndrome
How are most SCH fxs pinned?
Two lateral pins usually sufficient, can add a third
no significant difference in stability between three lateral pins and crossed pins
What is at risk with a medial cross pin?
ulnar nerve injury (3-8%); higher when placed in hyperflexion
Biomechanically strongest to torsional stress
What is the most common complication with CRPP of SCH fx in peds?
Pin migration ~2%
Infection 1-2.5%
Which deformity in a SCH can lead to a tardy ulnar n palsy?
Cubitus valgus
Cubitus varus is usually just cosmetic (caused by nonunion)
How is post operative stiffness treated after CRPP and casting of SCH fx in peds patients?
No PT necessary, resolves by 6 months
