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Supracondylar Humerus Fractures:

12/12/2014

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HPI: 7 y/o fall from monkey bars. Landed on extended shoulder + outstretched arm.

Physical exam: Obvious arm deformity. Ecchymosis over distal/medial arm. Inability to flex thumb IP joint and DIP of index finger (AIN neuropraxia). Palpable pulses. Warm extremity.
Picture
AP showing mild varus angulation    

Picture
Lateral film showing significant posterior displacement of distal portion of fracture
Picture
 Normal lateral film
Picture
Normal AP flim showing Baumann's angle: angle btw humerus and capitellar physis. This measures amount of varus/valgus deformity
Supracondylar Humerus Fractures:
Two categories:
·       Extension: Distal fragment displaced anteriorly (95% of cases).
·       Flexion: Distal fragment displaced posteriorly (5% of cases).

Four Types:
·       I: Nondisplaced: look for posterior fat pad
·       II: Displaced. Posterior cortex intact
·       III: Completely displaced
·       IV: Complete periosteal disruption with instability on flexion and extension.

Presentation:

·       Usually from fall on outstretched hand.
·       Frequently will have neurologic findings:
·       Anterior Interosseus Neuropraxia:
·       Most common neurologic finding. Particularly with extension-type fractures.
·       AIN is a branch of Median nerve.
·       Patient's cannot flex thumb IP joint or index DIP joint (Can't make an “OK” sign).
        Almost all will resolve with conservative management.

       Also have vascular compromise in approximately 1%
       Usually brachial artery compromise
       High collateral flow, so patient may have a pink, but pulseless extremity. Still requires emergent reduction.

Treatment:
       Type I: Immobilization at 90 degrees and ortho follow-up.
       Type II: Closed reduction unless displacement is minimal.
       Adequate reduction: Baumann's angle wnl, anterior humeral line transects capitellum
       Type III: High-risk for neurovascular complications. Get ortho involved. Almost always require closed reduction + pinning vs. open reduction
     Type IV: Open surgical reduction and fixation

       Indications for open reduction:
       1.) Inadequate reduction with closed techniques
       2.) Vascular injury
       3.) open fracture
       4.) Type iv fracture

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  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction