- See:
-
Percutaneous Pin Fixation:
-
Type III Supracondylar Frx:
- Indications:
-
vascular injuries
- inadequate
reduction;
-
brachialis may become interposed at frx site or by proximal humeral frx fragment button-holed thru brachialis (see
physical exam);
- if this occurs, closed reduction w/ longitudinal traction may worsen tightening of the muscle around protruding fragment;
- periosteum:
- tears proximal to frx site, and may become interposed into anterior frx gap;
- w/ interposed periosteum open reduction is required;
- Surgical Approach for Inadequate Reduction:
- consider the standard
posterior approach;
- alternatively limited medial and lateral incisions allow direct access to the entire surface of the fracture and should
guarantee protection for the nerve;
- Surgical Approach for Vascular Injury:
- begin w/ transverse incision over antecubital fossa, and subsequently decide if further exposure is needed on the proximal-medial side vs. the distal-lateral side;
- posterolateral Displacement:
- need to visualize the medial spike of the proximal fragment and to explore the
median nerve and
brachial artery;
- consider anteromedial approach;
- posteromedial Displacement:
- need to visualize the lateral spike of the proximal fragment and
radial nerve;
- consider anterolateral approach:
- w/ either approach, reduction requires hyperflexion, which precludes adequate visualization of frx site;
- attempt to palpate frx reduction as elbow is hyperflexed;
- following frx reduction, insert crossed pins thru stab incisions; (
cross pinning technique);
- Case Example:
- 3 year old child who sustained a type III supracondylar fracture following a fall;
- on physical exam there was subcutaneous ecchymosis (bone has buttonholed thru brachialis);
- an attempt was made at closed reduction and pinning, but this resulted in marked decrease in pulse;
- an open reduction was subsequently performed and the brachial artery was noted to be partially entrapped at the fracture site;
- Case Example:
- 7 year female who presented with a displaced supracondylar fracture - an attempt at closed reduction was carried out, but the reduction was unacceptable;
- open reduction was carried out via limited medial and lateral incisions;
Supracondylar fractures of the humerus in childhood: range of movement following the posterior approach to open reduction.
The operative management of supracondylar fractures.
Supracondylar fractures of the humerus in childhood: range of motion following the posteiror approach to open reduction.
TF Sibly et al. Injury. Vol 22. 1991. p 456-458.
The posterior approach to the elbow revisited.
MA Gruber MD and WA Healey MD.
J. Pediatric Orthopedics. Vol 16. 1996. p 215-219.
Open reduction and pin fixation of severely displaced supracondylar fractures of the humerus in children;
L Danielsson.
Acta Orthop Scand. Vol 51. 1980. p 249-255.
Surgical treatment of displaced supracondylar fractures of the humerus in children. Analysis of 52 cases followed for 5-15 years.
AJ Weiland et al.
JBJS 60-A. 1978. p 657-661.
The operative management of the difficult supracondylar fracture of the humerus in children.
GM Hart. Injury. Vol 9. 1977. p 30-34.
Operative reduction and fixation of a difficult supracondylar extension fracture of the humerus.
Kekomaki.
J. Pediatric Orthopedics. Vol 4. 1984. p 13-15.
Open reduction and internal fixation of displaced supracondylar fractures of the humerus in children.
PG Shifrin.
Orthop Clin North Am. Vol 7. 1976. p 573-581.
