Review article: Paediatric supracondylar humeral fractures: Emergency assessment and management

Abstract

Supracondylar humeral fractures in children are common presentations to the ED but might be challenging to both diagnose and assess clinically. The ED has a critical role in accurately assessing the child, the limb's neurovascular status and initiating treatment. A specific approach to the clinical assessment of such a child is required as failure to detect neurovascular compromise can delay appropriate treatment and result in serious consequences. Most children can be investigated with X-ray radiograph alone with further treatment directed by severity of the fracture, commonly described using the Gartland classification. Our review article provides an overview of supracondylar humeral fractures and a suggested clinical approach to leave the emergency physician better equipped to assess and manage these fractures.

Can online technology be reliably used to improve education? A prospective study using neurovascular examination of the upper and lower limbs

“…One study reported 22% of nerve injuries with Grade 3 open fractures of the tibia (Beltran et al, 2012). In displaced supracondylar fractures of the humerus, nerve injuries can occur in up to 15% of patients (Allen, Hang, & Hau, 2010) and 1% in total hip arthroplasty (Schmalzried, Noordin, & Amstutz, 1997).…”

Orthopedic versus surgical treatment of Gartland type II supracondylar humerus fracture in children

“…They occur most frequently within the first decade of life, with a peak of incidence between 5 and 8 years of age [1][2][3]. This injury occurs during the time when capsule and ligaments supporting the elbow have greater tensile strength than the bone itself, which occurs during the metaphyseal remodeling that takes place during the first 10 years of development; thus, the incidence of these fractures decreases after the age of 15.…”

“…Vascular injuries involving the brachial artery occur in 0.5% of patients [2]. Neurological injury is B10-20%, mostly affecting the anterior interosseous branch of the median nerve [1]. The ulnar and radial nerve can also be injured.…”

“…An extension-type fracture pattern occurs in up to 98% of cases. The flexiontype pattern is seen in less than 2% of cases [1,4,6]. Gartland initially classified three types of extension-type supracondylar humeral fractures on the basis of the degree of displacement and the existence or absence of an intact cortex [7].…”

“…Supracondylar humeral fractures are very common in children, accounting for B60% of all elbow fractures [1]. They occur most frequently within the first decade of life, with a peak of incidence between 5 and 8 years of age [1][2][3].…”