كسور المرفق (الكوع) عند الأطفال - كسور فوق لقمتي العضد supracondylar humerus fractures in children

supracondylar humerus fractures in children: The fracture line typically propagates transversely across the distal humerus just above the joint. Extension supracondylar fractures Supracondylar flexion fractures . symptoms and diagnosis: The doctor should suspect the diagnosis of a supracondylar fracture in children with swelling and/or pain at the distal humerus with inability to move the arm or significantly limited range of motion after an extension injury such as a fall on an outstretched hand. Brisk capillary refill, normal color, and a warm hand indicate the presence of some distal perfusion, even when distal pulses are diminished or absent. diminished or absent pulses in association with poor distal perfusion, pallor, and a cool hand are concerning signs of ischemia, especially in association with pain upon passive extension of the fingers Patients with these findings warrant emergency intervention to reestablish limb perfusion. The doctor should evaluate the sensory and motor function of the median, radial, and ulnar nerves while minimizing arm movement. Patients with signs of acute compartment syndrome require emergency pediatric orthopedic consultation. Signs of compartment syndrome include: •Excessive swelling and ecchymosis at the elbow •Increasing forearm pain •Increased pain upon passive extension of the fingers •and a cold hand with poor perfusion, pallor, and diminished or absent pulse (late finding) Radiographic diagnosis: If a physical examination shows likelihood of a fracture, the doctor will use X-rays to confirm the diagnosis, and to distinguish a supracondylar fracture from other possible types of injuries. Radiographic diagnosis of a supracondylar fracture requires anteroposterior (AP) and true lateral views of the elbow. The doctor should not permit active or passive elbow movement in a patient with a suspected supracondylar fracture until a displaced fracture has been excluded by radiography. Excessive manipulation of the extremity during radiologic procedures may further exacerbate or precipitate neurovascular injury in patients with displaced fractures. for this reason, splinting is advisable prior to obtaining radiographs. Distal neurovascular status should be checked before and after splinting. If any new decrease in pulse or neurologic deficit is found after immobilization, then the splinting material should be removed, the arm position adjusted, and the splint reapplied. A true lateral view of the elbow is essential because the majority of classifications and treatment algorithms are based on the degree of extension or flexion displacement. The main anatomical landmark to be evaluated in the lateral view is the anterior humeral line . This line continues the anterior cortical of the humerus . in a normal elbow, should traverse the capitellum in its middle third. In a displaced fracture in extension, the line will pass anteriorly or may not even cross the capitellum. In case of a flexion-type fracture, the line passes posteriorly to the capitellum. The posterior fat-pad sign is a lucency on a lateral view along the posterior distal humerus . Supracondylar fracture classification: Gartland classification system. Gartland type I supracondylar fracture : nondisplaced fracture type II fracture refers to a displaced fracture with an intact posterior periosteum. Gartland type III fracture is a displaced fracture with no continuity between the proximal and distal fracture fragments. For children with adequate distal circulation and no sign of compartment syndrome, definitive care is determined by the degree of displacement on plain radiographs. Patients with a nondisplaced Type I fracture may be immobilized using a posterior splint. the splint should extend from the wrist to the axilla, with the elbow at 90 degrees of flexion and the forearm in neutral position with respect to supination and pronation. Circumferential casting and extremes of flexion should be initially avoided in most cases to decrease the incidence of compartment syndrome and vascular compromise. Neurovascular status should be checked before and after splinting. The typical duration of immobilization for this type of fractures is three weeks. Type II fractures require orthopedic closed reduction and percutaneous pin fixation.