No abstract

Level IV.

Introduction: Supracondylar fractures are one of the most common fracture patterns sustained by children, and one of the most common injuries requiring operative fixation. Understanding the complications associated with supracondylar fractures is vital for the practicing orthopedic surgeon. This analysis of supracondylar fractures examined the clinically important aspects including vascular injury, compartment syndrome, neurological injury, brachialis entrapment, associated injuries, and etiologies of injury. Recent advances in technology have resulted in a myriad of new forms of recreational equipment for children to play with. The purpose of this study is to compare the historical literature, the current literature, and a single surgeon's sample of supracondylar fractures. In addition, this study aims to evaluate if any changes in epidemiology or etiology have occurred due to the development of new recreational equipment. Objective: The purpose of this study is to evaluate and provide a qualitative overview of the epidemiology of displaced supracondylar fractures, to compare historically reported numbers to more recent literature as well as a single surgeon sample, and to evaluate if changes in epidemiology or etiology have occurred due to the new recreational equipment that children use. Methods: Some 75 displaced supracondylar elbow fractures were reviewed. Data elements recorded from the electronic medical record (EMR) included patient age, gender, height, weight, handedness, date, time, location, mechanism, Gartland classification, concurrent injuries, and neurovascular status. Results: In this study, there were 42 males and 33 females. The average age was six years. Some 70 of the 75 patients were older than the age three. One fracture was open, nine fractures had a pucker sign, seven presented with a nerve palsy, four presented without a pulse, and seven patients presented with an additional ipsilateral distal radius fracture. All fractures were the result of a fall. Falls from playground equipment resulted in 29 fractures. There were 10 from falls off of furniture, six from falls during sports, three from falls on the stairs, and three from fall off of bikes. The remaining fractures resulted from running, tripping, falling from a toy ball, sled, tree, wagon, fence, bounce house, van, deck, power wheels car, ATV, and a go-cart. Some 64 fractures were transferred from 27 different outside hospitals. Eleven fractures presented directly to the ED. Twenty-six fractures occurred during the summer, 20 occurred in the autumn, 6 occurred in the winter, and 23 occurred during the spring. Some 35 fractures occurred at home, 30 on the school grounds, four in a gymnasium, four in a park, one at a farm show, and one in a parking lot. Some 25 fractures were treated between midnight and 8 am, 16 were treated between 8 am and 5 pm, and 34 were treated between 5 pm and 1 2 3 4

Extension type supracondylar humerus fractures in children commonly displace in two directions: posteromedial and posterolateral. The traditional maneuver to reduce posteromedial displaced fractures utilizes pronation of the forearm, while the maneuver for posterolateral displaced fractures utilizes supination. Traditional teaching suggests that the periosteum is an aid to reduction. The purpose of this study is to take a second look at this periosteal hinge theory and reexamine the maneuver performed when reducing an extension type 3 supracondylar fracture. Sixty-nine consecutive displaced extension type 3 supracondylar fractures were studied. Intraoperative fluoroscopic radiographs were graded as posteromedial, posterolateral, or direct posterior displacement. All fractures were treated with closed reduction and percutaneous pinning. The best maneuver used to align the fracture during surgery was recorded in the operative note. The direction of displacement on radiographs was 32 (46.3%) posteromedial, 31 (45%) posterolateral, and six (8.7%) direct posterior. All of the 32 posteromedial displaced fractures were best aligned when pronation was utilized. All of the 31 posterolaterally displaced fractures were best aligned when supination was utilized. The six direct posteriorly displaced fractures obtained the best alignment in pronation. The current study reaffirms the classic teaching that the direction of displacement of the fracture indicates the site of the intact periosteum. The intact periosteal hinge can be used to obtain fracture reduction.

No abstract

Introduction: Skull, rib, corner fractures, and fractures in children who have not started walking are highly associated with abuse. The majority of fractures stemming from abuse occur in children less than two years of age. The purpose of this study is to determine the etiology and relationship of displaced supracondylar elbow fractures with child abuse.Materials and Methods: Seventy-five displaced supracondylar elbow fractures were reviewed to determine how the injury occurred. Medical records and radiographs were analyzed for demographics, cause of injury, age of injury, injury data, and for the presence of a child abuse investigation. Transphyseal fractures were excluded.Results: Forty-two males (56%) and 33 females (44%) were studied. The average age was 6 years old (range: 1-year-5-months to 12-years-4-months). Two patients were 1 2 years of age, 3 were 2 3 years of age, and 70 were older than 3. All 75 were displaced supracondylar fractures. One fracture was open. All fractures stemmed from a reported accidental fall, including: falls from--playground equipment 29 (39%), furniture 10 (13%), sports 6 (8%), stairs 3 (4%), bikes 3 (4%), and miscellaneous: running, falling, sledding, tree, wagon, fence, bounce-house, van, deck, power-wheels car, ATV, and go-cart. Outside physicians, orthopaedic surgeons, emergency department physicians, residents, nurses, and technicians evaluated each patient. All of them are able to submit for an evaluation if they suspect abuse. Only 1 patient aged 1-year-5-months, injured from a reported fall at home during a tantrum, was reported for possible abuse. The child abuse evaluation was negative. Discussion and Conclusion:Pediatric supracondylar fractures occur from accidental falls while children are at play. Most supracondylar fractures occur in children over the age of two. In the current series, 73 out of the 75 cases involved individuals that were two years of age or older. Child abuse is rarely associated with displaced supracondylar fractures in children.