Supracondylar Fracture

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Supracondylar Fracture

  1. 1.  A 7yo female presents with elbow pain after FOOSH. Exam reveals minimal swelling and severe pain of her right elbow
  2. 2.  Fat pads  Displacement (“sail sign”) of anterior fat pad  Posterior fat pad is always abnormal  Anterior humeral line  Draw a longitudinal line along anterior border of humerus on lateral view  If line falls in anterior third or entirely anterior to capitellum, a posteriorly displaced supracondylar fracture is likely
  3. 3.  Nondisplaced fractures  Immobilized with elbow flexed to 90°  Displaced fractures  In pediatrics, if posterior cortex is intact, fx can be managed with closed reduction and percutaneous fixation by the orthopedist  If fracture is open, not reducible by closed means, coexists with forearm fractures or has NV compromise after closed reduction, open reduction is warranted  Orthopedics  Should be consulted to determine management of any displaced supracondylar fractures  Disposition  Even if closed reduction successful, most of these injuries require admission for serial exams because of risk of compartment syndrome  Discharged pts require careful return instructions
  4. 4.  Traditionally a pediatric fracture, but can be in adults  Pediatric fractures often occur through growth plates, so a fracture line may not be visible; therefore, you must check for abnormal fat pads and misalignment!  Palpate distal radius  Associated fracture in 5-6%  Risk for nerve damage  Anterior interosseous branch of median nerve  Less commonly, radial nerve  Vascular compromise  Occurs in 5-17% from brachial artery injury or compartment syndrome  Volkmann’s ischemic contracture is a devastating consequence of missed vascular injury
  5. 5.  Marx J MD; Hockberger R MD; Walls R MD. Rosen’s emergency medicine. 7th ed.  Simon R; Sherman S; Koenigsknecht S. Emergency orthopedics: the extremities. 5th ed. McGraw Hill Publishing.  Wheeless C R III MD. Wheeless textbook of orthopedics. www.wheelessonline.com.

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