Compartment syndrome – Minimize risk with immediate intervention for Type 3 injuries associated with vascular compromise.The need for range of motion exercises or formal physical therapy is controversial. Duration of immobilization is approximately 3 to 4 weeks.In the presence of vascular compromise or compartment syndrome, emergent intervention is essential. Type 3 – Treatment consists of closed reduction and percutaneous pinning.With either treatment method, critical analysis of Baumann’s angle and the anterior humeral line are important. Treatment may consist of placement of a long arm cast with close follow-up or closed reduction and percutaneous pinning. Type 2 – There are differing opinions on the treatment of Type 2 supracondylar humerus fractures.Type 1 –Place in a long arm cast, elbow flex ≤ 90 degrees.In general, the Gartland Classification can be used for a basic treatment algorithm.Lateral radiograph – anterior humeral line, posterior fat pad sign.AP radiograph – Baumann’s angle, assess medial comminution.It is not recommended that additional studies (arteriogram) be obtained for evaluation of a pulseless supracondylar humerus fracture as this may unnecessarily delay treatment.AP and lateral radiographs of the forearm are obtained to rule out associated fractures of the forearm (floating elbow).An oblique image of the elbow can also be obtained. Elbow imaging includes AP and lateral radiographs of the elbow.Important findings include warmth, capillary refill, and the presence or absence of a radial pulse by palpation and/or Doppler ultrasound. The perfusion status of the extremity should be noted.A detailed neurologic examination is performed in all patients to include both motor and sensory function.Look for antecubital ecchymosis, skin puckering, forearm swelling to indicate a more severe injury.Elbow pain, tenderness, swelling, decreased range of motion are standard findings.Neurovascular compromise upon presentation in less than 10%.Young children, ages 3 years to 7 years most common.Occult supracondylar humerus fractures are common and suspected when there is a history of trauma, tenderness in the supracondylar region, and a radiographic elbow effusion (posterior fat pad sign).Type 4 – a controversial category describing a fracture that is unstable in flexion and extension, implying a lack of intact periosteum.Type 3 – complete displacement with no bony hinge.Type 2 – angulation present but a posterior bony hinge remains intact.There is an intervening thin area of bone connecting the olecranon fossa and coronoid fossa, which is the location of most supracondylar humerus fractures. Anatomy of the distal humerus includes medial and lateral columns. Common elbow fracture in young children.Closed reduction and percutaneous pinning is the mainstay of operative treatment.Awareness of signs that indicate a more severe fracture and appropriate timing of intervention are important factors to consider to minimize the risk of complications.Gartland classification can be used to formulate treatment algorithm.Radiographic evaluation includes assessment of the anterior humeral line and Baumann’s angle.Common fracture treated by pediatric orthopaedic surgeons.Study Guide Supracondylar Humerus Fractures Key Points:
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