Healed after 3 months and still asymptomatic at 2 years. Most common elbow fractures seen in children 5 to 6yrs boys vs gals 3. Fixatorassisted plating in pediatric supracondylar femur fractures. Distal femur, fracture, supracondylar and intercondylar fracture, internal fixation, biomechanics. It take a great deal of force to break the thigh bone. The ulnar nerve with its posterior location is uncommonly involved with a typical extensiontype supracondylar fracture. The anatomy of the distal femur explains the three major types of fracture. The extension type occurs when a child completely straightens their arm to brace for a fall, which sounds normal enough, and in most cases nothing happens. This summary does not contain rationales that explain how and why these recommendations were developed nor does it contain the evidence supporting these recommendations.
Femoral shaft fractures orthopaedic trauma association. The full text of this article is available in pdf format. Comminuted supracondylar femur fractures aoota 33a3 are commonly treated with locked plates. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. Pdf analysis of management of supracondylar femur fracture by locking compression plate authors. Pre op xray anteroposteriorap and lateral xray of thigh. Supracondylar femoral fracture supracondylar refers to the part of the femur just above the knee joint. Postoperative comprehensive nursing care improved the prognosis. Distal femoral fractures pose a difficult problem for the surgeon with significant complication rates and generally unsatisfactory results. The omega3 supracondylar plate is indicated for fractures of the distal femur which may include. A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint.
Supracondylar fracture teachmesurgeryteachmesurgery. Retrograde intramedullary nailing in supracondylar femoral. A, an anteriorposterior view shows a fairly subtle lucency through the distal humerus. This type of fracture is referred to as a supracondylar humerus fracture. Although you may recognize this as a fracture, the degree of displacement appears minimal. Help with complete thesis work available for download in all subjects. Orif of supracondylar region of femur doesnt normally take place unless there is a fracture, and is not necessarily a part of revision of tkr. Background supracondylar fractures are associated with a high incidence of neurovascular complications. Neurovascular assessment can be difficult due to pain, anxiety and the young age of these patients.
Among these, 19 had an a1 simple extraarticular fractures fig 2 and four had a b2 medial condylar sagittal plane fractures. There is no clear evidence in the actual literature regarding which of the surgical approaches could bring about the best functional, cosmetic, and radiological outcomes, as well as fewer complications, when an open reduction and pinning of a severely displaced supracondylar humerus fracture is performed. The pulseless supracondylar fracture remains an emergency 8, 9. Supracondylar fracture occurs commonly in distal humerus.
Feb 10, 2014 supracondylar femur fractures can cause peroneal nerve injury. Clinical efficacy of augmented medial assisted plate for treating. Supracondylar humeral fracture radiology reference. This is a type of fracture that is most common in children but one that you rarely see in an adult but may occur in the elderly who are suffering from weakened bones or osteoporosis. Open l potts fracture close fracture lateral condyle femur close comminuted supracondylar fracture open tshapedcomminuted supracondylar fracture open tshapedsupracondylar fracture with knee joint involvement open comminuted supracondylar fracture close supracondylar fracture open comminuted supracondylar fracture.
Pdf analysis of management of supracondylar femur fracture by. The surgery can be difficult in an elderly, frail patient and a rapid return to function is desirable. Simple supracondylar fractures are typically seen in younger children, and are uncommon in adults. But in rare cases when there is too much force with the fall like seen when falling off the monkeybars, our muscles that bend the elbow. These injuries are often complicated by osteopenia of the distal femur secondary to stress shielding or osteolysis. Immediate weight bearing of comminuted supracondylar femur. A fracture of the ulna associated with a dislocation of the top of the radius at the elbow is called a monteggia fracture. The second recent trend is that divergent lateral pinning has replaced cross pinning, reducing ulnar nerve injuries.
Pdf supracondylar fracture of the femur in children. As a result, they are typically comminuted or involve osteoporotic bone. There is a bimodal distribution, with young patients with high energy trauma and elderly patients with lowenergy falls. Evaluate the ipsilateral hip for dislocationinjury evaluate the popliteal fossa for hard signs of vascular injury. The most common cause of a fracture is direct trauma to the leg from an automobile accident or a fall.
The backslab and sling should be placed under figure 2. Open supracondylar fracture of femur short description. A dvances in the design and application of intramedullary im devices by the orthopaedic community have revolutionized the care of traumatic. Introduction of all femoral fractures, approximately 47% are distal femur fractures kolmert, 1982. Jan 28, 2019 supracondylar fracture occurs commonly in distal humerus. Because of the anatomy of the distal femur, only surgical treatment is indicated to stabilize the fracture. Supracondylar nailing for difficult distal femur fractures. In addition to the t2 femoral nailing system, stryker developed the t2 supracondylar nail scn for the treatment of complex distal femoral fractures. On lateral view the anterior humeral line is anterior to the middle of capitellum.
Supracondylar and intercondylar fractures of the femur. Periprosthetic fractures of the distal femur most commonly present as fragility fractures associated with relatively minor trauma. Oblique sc fracture of a patient with hxo prosthetic knee. Fracture at the proximal end of a supracondylar nail treated with a plate elderly f preexisting healed supracondylar femur fracture new fracture at end of rod after mva treatment. Periprosthetic fracture for hip periprosthetic fixationstandard is with plate or allograft or. Supracondylar and intercondylar fractures of the femur springerlink. Supracondylar femoral fracture central coast orthopedic. Chapter 53 fractures of the distal femur china quad diaries. Diagnosis and management about in brief in brief has been developed by pediatric orthopedic specialists at gillette childrens specialty healthcare as a resource for primary care providers.
Epidemiology simple supracondylar fractures are typically seen in yo. Overview this condition is a break in the femur at the knee joint. Outcome of supracondylar femur fracture in adults managed by. Supracondylar femoral fracture extrarticular distal femoral fracture ao 33c type. Kids broken elbow supracondylar fracture bone talks. Documentation of neurovascular status in supracondylar. Humerus fractures diaphyseal fractures in children fractures of distal femur are very difficult to treat. If the dislocation is not recognized, and only the fracture is treated, it can lead to permanent impairment of elbow joint function. Metaanalysis of postoperative complications in distal femoral. Supracondylar fractures of femur have a bimodal age distribution, with a high incidence in young adults from high energy trauma, such as motor vehicle accidents and a.
Comparative study of functional outcome of supracondylar fractures of femur treated with distal femur locking compression plate with that of supracondylar. Besides the t2 femoral nail with a 3m radius of curvature, stryker offers also a 1. Fractures of distal femur reportedly account for less than 1% of all fractures and 4%6% of all femoral fractures 1. Always check the web space between the 1st and 2nd toe. Supracondylar fractures are most common in patients who suffer from osteoporosis or have had total knee.
A biomechanical comparison of dualplate and platenail constructs. Pdf supracondylar fractures of the humerus in children. Nail will not have an isthmic fit may need blocking pinsdrill bitsscrews percutaneous or open clamps nail will lock a fracture in a malreduced position as easily as it will. Guy rubin an external file that holds a picture, illustration, etc. Displaced supracondylar fracture without intracondylar extension of lower end of right femur. The specific etiology of supracondylar humerus fractures in children is not well known. Fracture fixation is often compromised by poor bone stock and limited by the femoral prosthesis. Fractures in the supracondylar area characteristically deform with femoral shortening and posterior angulation and displacement of the distal fragment. They occur after a fall onto an outstretched arm, and they usually by falling off the monkeybars. To study the incidence and pattern of supracondylar femur fractures according to aoasif classification, to assess the treatment and longterm functional outcome for supracondylar femoral fracture using retrograde nail. If you have comments or questions, please contact jason kelecic, d.
The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. Supplemental fixation of supracondylar distal femur fractures. On the ap view, fracture lines can be seen through the metaphyseal bone of the distal humerus on either side of the olecranon fossa. These fractures usually occur in elderly patients with multiple comorbidities and osteoporotic bone. These fractures are more commonly seen in boys 4 these injuries are almost always due to accidental trauma, such as falling from a moderate height bedmonkeybars 4. The knee joint is the most complicated joint in the human body, and supracondylar fracture of the femur is a kind of severe distal femur fracture. Children more commonly suffer from this fracture than adults and it may cause serious complications if ignored. Sickkids parent information sheet supracondylar humerus fracture without displacement. Supracondylar fractures are a very common type of broken elbow seen in kids, especially ages 38 years old. Supracondylar femur fractures orthopaedicsone articles. Supracondylar soopruhkondehlahr femoral fracture also called distal distuhl femur fracture is when the thigh bone breaks at the knee.
Fracture union, sliding of hip screw, proximal femur shortening, and presence of complications were assessed radiologically at relevant followup intervals. Barr reported a higher incidence of supracondylar humerus fractures during the vacations 2. S70s79 injuries to the hip and thigh s72 fracture of femur 2020 icd10cm diagnosis code s72. A femoral fracture that involves the femoral head, femoral neck or the shaft of the femur immediately below the lesser trochanter may be classified as a hip fracture, especially when associated with osteoporosis. Femur fractures can be managed in a prehospital setting with the use of a traction splint. Complications of supracondylar fractures of the elbow. The toronto experience with the supracondylar fracture of the femur, 196672. Supracondylar humerus fractures are widely considered the most common fracture of the elbow in children. In many academic centers the treatment of the supracondylar humerus fractures is performed exclusively by the pediatric orthopedic surgeons. Supracondylar humeral fractures, often simply referred to as supracondylar fractures, are a classic pediatric injury which require vigilance as imaging findings can be subtle. Femoral corrective osteotomy for malunited supracondylar. Supracondylar fracture types, treatment, classification.
Pdf extension of the elbow and supracondylar fractures in. Gartlands classification of supracondylar fracture of humerus galeazzi fracture a fracture of the radius with dislocation of the distal radioulnar joint colles fracture a distal fracture of the radius with dorsal posterior displacement of the wrist and hand smiths fracture a distal fracture of the. Download full thesis topics for ms dnb orthopaedics degree. Download thesis pdf files, complete thesis dissertation work. Distal femur fractures orthopaedic trauma association. The most common mechanism is an indirect trauma on a bent knee, and more rarely direct trauma by crushing. In the 1960s treatment involved being treated in a traction bed for eight weeks, a fracture brace, then weight bearing might start again at 3 months from injury. Salterharris type ii fracture of the femoral bone in a 14.
Supracondylar humeral fractures are a common paediatric elbow injury, but are almost never seen in adults the peak age of incidence is between 57 years. Outcome of supracondylar femur fracture in adults managed. Pediatric femoral supracondylar fractures are difficult to reduce by. Supracondylar fractures are most common in patients who suffer from osteoporosis or have had total knee replacement surgery.
Radiographs of the elbow show a displaced supracondylar fracture. This does not cause functional disability and should not be treated with physiotherapy. The main reason is the anterior or lateral impact forces on a flexed knee. Patients with supracondylar fractures will often have prolonged period months of inability to fully extend their elbow. The normal anatomic axis of the distal femur is 6 to 7 degrees of valgus in a male and 8 to 9 degrees in a female. When a broken bone breaks through the skin, it is called an open fracture. The lateral cortex of the femur has a 10 degree slope, and the medial cortex slopes 25 degrees. Babst department of trauma surgery, cantonal hospital lucerne, lucerne, switzerland summary this paper describes current treatment strategies of distal femoral fractures as well as their evidence based rationale. The radial nerve lies posterolateral to the usual location of supracondylar fractures and, thus, is less commonly involved see fig. There are different kinds of breaks, from simple to serious. Hyperextension of the elbow causes an extension type supracondylar fracture seen in 95% of cases. These fractures were surgically treated by ao principles and fixation, and the surgery performed mainly by the two authors. Type iii fractures can lead to adverse physical, social, and emotional consequences if they are not treated effectively.
Oct, 2017 supracondylar femur fractures require anatomically stable internal fixation for best results, which usually necessitates surgical treatment. The nondominant extremity is most commonly affected. Dec 18, 2017 a supracondylar fracture is an injury to the humerus, or upper arm bone, at its narrowest point, just above the elbow. This 4yearold female fell from a couch onto her outstretched hand, sustaining a supracondylar humeral fracture. But, orif has already taken place, and the tkr is performed at both femoral and tibial component as per descriptiion, so we should code for the both. The femur is the largest and strongest bone in the body, so it takes tremendous force to cause a fracture. If age distribution is considered, in the 0 to 7 year age group, shf is easily the commonest fracture seen 28% 3. Current concepts 598 journal of the american academy of orthopaedic.
Supplemental fixation of supracondylar distal femur fracture. Supracondylar humeral fracture radiology reference article. A distal portion of the medial condyle should be intact for the lag screw to gain adequate purchase. Children under three years of age typically sustain a supracondylar fracture after a fall from a height of less than 3 feet eg, fall from a bed or couch. It account for less than 7% of all femur fractures 1. The femur is the largest and strongest bone in the body. Supracondylar fractures of the femur sciencedirect. The fracture can range from a small crack to a full break that allows part of the bone to separate.
Supracondylar fractures result from a fall on an outstretched arm in up to 70 percent of patients. Cross pinning technique used to stabilize supracondylar fracture of femur adversely affects flexion angles of stifle joint leading to joint stiffness compared to either of the end threaded pinning. The mean operation time and blood loss were significantly lower for the pfna group, but walking. All supracondylar humerus fractures treated at childrens hospital and health center, san diego chsd over. Supracondylar fractures of femoral bones in adolescents are most frequently caused by traffic accidents connected with high driving speed. In more severe fractures with intercondylar involvement, one often sees. Distal femur lecture orthopaedic trauma association. Supracondylar fractures are the most common type of upper arm injury in children. Supracondylar fracture pediatric pediatrics orthobullets.
Lower limb clinical and functional outcomes of treatment for. Femur fracture leads to reduced activity for 107 days, the average length of. Femur fracture reaming reaming of the femoral shaft fracture only pape j trauma 1993 has shown a deleterious pulmonary effect to immediate reamed intramedullary nailing in acute femur fracture patients with pulmonary trauma in both a retrospective analysis and multiple animal studies pape, j trauma 1992. This often resulted in a loss of independence, and in some instances. The omega3 supracondylar plate is also indicated for osteotomies of the proximal and the distal femur.
Comprehensive clinical evaluation is a necessity when children with these injuries present to the emergency department. The incidence of supracondylar fracture after total knee arthroplasty is approximately 1%. Effective management of periprosthetic fractures of the distal femur requires knowledge of both fracture fixation techniques and revision arthroplasty. Current concepts in fractures of the distal femur soucasny pohled na zlomeniny dolniho konce stehenni kosti b. Gartlands classification of supracondylar fracture of humerus. Orthopedics abstract this article presents a case of femoral corrective osteotomy for malunited supracondylar femoral fracture after total knee arthroplasty tka in a patient with rheumatoid. Fractures can range from a less severe, nondisplaced type i fracture to a more severe, displaced type iii fracture with no cortical contact. Raise the arm on a pillow when sitting or lying down loose fitting clothing, not through the sleeve. All readers of this summary are strongly urged to consult the full guideline and evidence. Periprosthetic proximal femur fractures after total hip arthroplasty are challenging. Newman bristol royal infirmary, bristol, uk introduction fractures at the upper end of the femur are occurring with everincreasing frequency and have now reached epidemic proportions boyce and vessey, 1985. Extra articular supracondylar femur fractures managed with. She is neurovascularly intact and the skin shows no evidence of open wounds.1315 1439 969 1341 441 65 1039 531 1162 708 220 852 30 572 1356 1422 587 511 83 108 272 373 585 449 1056 770 1323 673 1161 1465 325