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Definition: Fracture of the humerus just proximal to the epicondyles.
-Classification of fracture based on mechanism:
-Nondisplaced fractures may follow up with orthopedics within 1 week after posterior long arm splinting (elbow at 90 degrees & forearm in neutral position)
-Displaced fractures require prompt pediatric orthopedic consultation for closed reduction in OR vs operative repair.
-Obtain emergent orthopedic consultation for compartment syndrome, neurovascular compromise, or open fracture.
-Partial reductions in ED likely just increase soft tissue swelling and delay definitive reduction and should be reserved for rare cases of vascular compromise.
References:
Wheeless, CR. Pediatric Supracondylar Fractures of the Humerus. Wheeless’ Textbook of Orthopedics. [Accessed online 4/22/12.] http://www.wheelessonline.com/ortho/pediatric_supracondylar_fractures_of_the_humerus
Ryan, LM. Evaluation and management of supracondylar fractures in children. UpToDate. [Accessed 4/22/2012]. http://www.uptodate.com/contents/evaluation-and-management-of-supracondylar-fractures-in-children
- Extension type (majority >80%; distal fx segment displaced posteriorly)
- Flexion type (distal fx segment displaced anteriorly)
- Any diminished pulsations or capillary refill should cause concern for vascular compromise (arterial compression, tear, or compartment syndrome).
- Place a continuous pulse oximetry probe on the affected hand to monitor bloodflow.
- The radial, median, or ulnar nerves may be affected and should be assessed.
-Nondisplaced fractures may follow up with orthopedics within 1 week after posterior long arm splinting (elbow at 90 degrees & forearm in neutral position)
-Displaced fractures require prompt pediatric orthopedic consultation for closed reduction in OR vs operative repair.
-Obtain emergent orthopedic consultation for compartment syndrome, neurovascular compromise, or open fracture.
-Partial reductions in ED likely just increase soft tissue swelling and delay definitive reduction and should be reserved for rare cases of vascular compromise.
References:
Wheeless, CR. Pediatric Supracondylar Fractures of the Humerus. Wheeless’ Textbook of Orthopedics. [Accessed online 4/22/12.] http://www.wheelessonline.com/ortho/pediatric_supracondylar_fractures_of_the_humerus
Ryan, LM. Evaluation and management of supracondylar fractures in children. UpToDate. [Accessed 4/22/2012]. http://www.uptodate.com/contents/evaluation-and-management-of-supracondylar-fractures-in-children