The neer classification for proximal humerus fractures is based on 4 fracture parts. Type 5 is a type 4 with fracture of medial condyle osteoporoticbone can be associated with undisplaced supercondylar fx. Distal humerus fractures orthopaedic trauma association. Most distal humerus fractures are caused by some type of highenergy eventsuch as receiving a direct blow to the elbow during a car collision. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. These types of humerus fractures are most often caused by direct trauma and is commonly sustained in car. Supracondylar humerus fractures are the most common elbow fracture in children and have the highest complication rate for elbow fractures in this age group. A pucker, dimpling, or ecchymosis of the skin just anterior to the distal humerus may indicate that the proximal, anteriorly directed fragment has penetrated the brachialis muscle and possibly the subcutaneous layer as well fig. Proximal humerus fractures are common but debilitating injuries, which result in significant dysfunction for the patient and both diagnostic and treatment challenges for the physician. It has two thickened projections where it joins the elbow called epicondyles. The distal humerus is the end of the upper arm bone the humerus that forms the upper part of the elbow. Supracondylar fracture of the humerus is a common childhood injury to the elbow. The intercondylar fracture pattern is the most common type. Apply ice packs or use a cryo therapy ice machine to.
When the proximal humerus is broken, the fracture line predictably occurs along one or more of these planes. Humeral shaft fractures account for approximately 20% of fractures of the humerus in children. Lowenergy distal humerus fractures result from simple falls in the middleaged and elderly, either from a direct force or from transferred axial force from a fall onto an outstretched hand. The majority of proximal humerus fractures are sustained via low energy falls in the elderly. Supracondylar humeral fractures, often simply referred to as supracondylar fractures, are a classic pediatric injury which require vigilance as imaging findings can be subtle. Fractures of the humerus are classified in one of two ways. Supracondylar humerus fracture the humerus hu mer us bone is the long, thick bone in the upper arm that extends from the shoulder to the elbow. The humerus is the bone that makes up the upper portion of the arm. Proximal humeral fractures may present with many different configurations in patients with varying comorbities and expectations. A proximal humerus fracture is a break in the arm bone near the shoulder, or a broken shoulder. Can their jewelry on the ipsilateral armhand be removed. Pediatric supracondylar fractures of the distal humerus.
Knowledge of the complex bone and soft tissue anatomy of the shoulder is paramount in successful treatment of proximal humerus fractures. Nerve injuries associated with pediatric supracondylar humeral fractures. A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. Supracondylar fracture of the humerus is the second most common fracture in children 16. Are there any open wounds rare, but ensure the consultant has looked in the axilla. Pdf supracondylar fracture of the humerus in children. They are classified according to their location as proximal, humeral shaft, or distal fractures. In my 12 years of career, i have seen many intercondylar fractures resulting due to fall from motorbike directly on the tip of the elbow when one falls on the tip of the elbow, it drives the olecranon process is into the trochlea, resulting in bone. While some injuries might be humerus shaft fractures, a fracture just above these epicondyles is called a supracondylar fracture of the humerus. In an older person who has weaker bones, however, even a minor fall may be enough to cause a fracture. Humeral fractures account for 8% to 10% of fractures in dogs and 5% to % of fractures in cats.
Distal humerus anatomy medial epicondyle proximal to trochlea lateral epicondyle proximal to capitellum radial fossa accommodates margin of radial head during flexion coronoid fossa accepts coronoid process of ulna during flexion. Intercondylar fracture of humerus, its physiotherapy. Among these fractures supracondylar humerus fractures are one of the commonest requiring surgical intervention and have a. Supracondylar humeral fracture radiology reference. A fracture in this area can be very painful and make elbow motion difficult or impossible. Distal humerus fractures of the elbow orthoinfo aaos. The specific etiology of supracondylar humerus fractures in children is not well known. Download simple and complex fractures of the humerus.
Proximal humerus fractures commonly occur in the elderly, while distal supracondylar fractures are the most common type of fracture in the pediatric population. The olecranon and medial and lateral epicondyles preserve their normal equilateral triangular relationship unlike. The humerus also known as the upper arm bone is a long bone that runs from the shoulder and scapula shoulder blade to the elbow. With the recognised complications of cubitus varus, injury to any of the three major nerves around the elbow, absent radial pulse after fracture reduction, stiffness and the fortunately rare incidence of volkmanns ischaemic contracture, an appropriate understanding of the pathology and management of this. A distal humerus fracture is one type of elbow fracture. All supracondylar humerus fractures treated at childrens hospital and health center, san diego chsd over. Simple and complex fractures of the humerus a guide to. Traditionally, humeral shaft fractures have been described according to the following features. Location proximal, middle, or distal type of fracture line transverse, oblique, spiral, comminuted, or segmental opened or closed status this article focuses on midshaft humerus fractures.
A proximal humerus fracture usually occurs close to the shoulder joint and can be located at. Bicondylar intraarticular fractures of the distal humerus. Supracondylar humerus fractures pediatric orthopaedic. Video lecture with narrations and live annotations from. Upper extremity fractures account for up to 90% of pediatric fractures. Stans, in morreys the elbow and its disorders fifth edition, 2018. Simple supracondylar fractures are typically seen in younger children, and are uncommon in adults. Anatomy of the distal humerus includes medial and lateral columns. If treated quickly, either by immobilizing with a cast or. The anatomic location of the fracture, fracture pattern transverse, oblique, spiral, and amount and direction of angulation and displacement are criteria used to describe fractures. A guide to assessment and treatment pdf free download. Cheng1 reported it to be the second most common fracture in childhood 16. Distal humerus fractures of the elbow the three bones that come together to form the elbow can break fracture in different ways.
The swelling and bruising may go below the elbow into the wrist and hand or into the front of the chest. They occur between the age of 2 and 15 yr, and most frequently between 3 and 8 yr. Approximately onethird of humeral fractures occur in this region. Humerus fracture upper arm fracture johns hopkins medicine. A proximal humerus fracture is the most common fracture of the shoulder, lying at the upper end of the humerus, or arm bone. Pdf supracondylar fractures of the humerus in children. Humerus fracture knowledge for medical students and. Supracondylar fracture pediatric pediatrics orthobullets.
When resting, sit with the elbow and forearm supported with pillows and elevated icing. Fracture that involves the epiphyseal plate or growth plate of a bone type i. Gartland classification modified type 1 nondisplaced. Fracture of shoulder and humerus linkedin slideshare. Intercondylar fracture of humerus results because of direct fall on the tip of the elbow.
A guide to proximal humerus shoulder fractures by mr devinder garewal march 3, 2019 march 6th, 2019 no comments your shoulder joints are some of the most important and mostused joints in your body, so its only natural that any injury or problem with the joints should be taken particularly seriously. A humerus fracture is a break of the humerus bone in the upper arm. It generally results from a fall on the outstretched hand 70. Humerus fractures can result from direct or indirect trauma. The supracondylar fracture is a common fracture of childhood. Humerus, proximal, articular fracture with slight displacement 11c1 1. Treatment is usually closed reduction and percutanous pinning crpp, with the urgency depending on whether the hand remains perfused or not. As with any displaced intraarticular fracture, the principles of anatomic restoration of the articular surface, stable fixation, and early motion are the optimal treatment goals. The treatment of humeral fractures is a complex issue and the source of. There may be a decreased ability to move the arm and the person may present holding their elbow. Gartlands classification of supracondylar fracture of humerus. As a result, the treating physician must understand the fracture pattern, the quality of the bone, other patientrelated factors, and the expanding range of reconstructive options to achieve the best functional outcome and to. Complications may include injury to an artery or nerve, and compartment syndrome the cause of a humerus fracture is usually physical trauma such as a.
Pediatric supracondylar fractures are one of the most common traumatic fractures see in children and most commonly occur in children 57 years of age, usually from a fall on an outstretched hand. This is due to the trauma from the fracture and from the surgery. Supracondylar fractures of the humerus have been recognised since the time of hippocrates and are one of the more common fractures in children. Supracondylar fractures of the humerus are the most common fractures in children. Free download simple and complex fractures of the humerus. Your childs humerus is fractured broken near the elbow area, just above the joint.
With the recognised complications of cubitus varus, injury to any of the three major nerves around the elbow, absent radial pulse after fracture reduction, stiffness and the fortunately rare incidence of volkmanns ischaemic contracture, an appropriate understanding of the pathology and. A guide to proximal humerus shoulder fractures melbourne. Pdf download for the biomechanics of proximal humeral fractures. No classification scheme for humeral shaft fractures. Welcome to the world of supracondylar fractures fracture of children not scary but spectacular it is a great teacher teaches you the values of basics in orthopedics it is kind and forgiving if you make a mistake cubitus varus, it forgives you no functional impairment but will not allow you to forget. These types of elbow fractures are fairly uncommon. There is an intervening thin area of bone connecting the olecranon fossa and coronoid fossa, which is the location of most supracondylar humerus fractures. Supracondylar humerus fracture orthopedics medbullets. What is the neurovascular status especially axillary and radial nerves. The guest edited thematic issues are published free of charge. If the fracture is completely displaced at the distal humerus, the arm assumes an sshaped deformity fig. Underreduced supracondylar fracture of the humerus in children.
Humeral shaft fractures pediatric orthopaedic society of. A distal humerus fracture affects the elbow and is a break in the lower end of the humerus. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. Pdf nonoperative treatment of proximal humerus fractures. Supracondylar fractures of the humerus sciencedirect. Supracondylar fractures of the humerus in children vumedi. Proximal humerus fractures sarasota orthopedic kwoc. Supracondylar fractures of the humerus are one of the most common fractures of childhood. The fracture is a metaphyseal injury that does not involve the physis or. To obtain reproducible results, an established treatment protocol is required and is described in detail here. Supracondylar humerus fracture nationwide childrens.
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