No dopplerable pulse, no capillary refill in hand = vascular exploration and repair. Dopplerable pulse, brisk capillary refill = inpatient observation. Pulseless: Closed reduction and pinning and re-evaluation.Type III=no cortex in continuity=CRPP/ORPP.Reduce by flexing elbow and pronating forearm Restore ant hum line, Baumanns angle <9, cast with elbow at 90 degrees and forearm in neutral Flexion(rare)caused by falling on flexed elbow.Extension(90-98%) caused by fall on an outstretched hand with the elbow hyperextended.Pediatric Supracondylar Humerus Fx Classification / Treatment Jones view=a/p view of distal humerus with elbow maximally flexed, difficult to interpret.posterior fat pad = 76% incidence of occult fracture.If measuring from a perpendicular to humeral axis normal = 9-26 degrees 5degree change in Baumann angle = 2 degree change in carrying angle. As Baumann angle increases the carrying angle decreases. humeral-capitellar (Baumann's) angle normal =75 degrees, best to compare to uninjured side.In children <4yrs old it passes equally through the middle 1/3 and anterior 1/3. Anterior humeral line passes through the middle 1/3 of the capitellum.long axis of ulna lines up or slightly medial to long axis of humerus on true AP.proximal radius points to capitellum in all views.Classification:Gartland Type I,II or III. Result: routine healing, delayed healing, malunion, or nonunion. Fracture pattern: transverse, oblique, spiral, comminuted, segmental, longitudinal, greenstick. Location: Right / Left name of bone specific location on bone (shaft, neck, base, condyle etc) . Pediatric Supracondylar Humerus Fx Xray / Diagnositc Tests Assess soft tissues, especially note if fracture is open or closed.detailed NV exam, especially note AIN function.Pediatric Supracondylar Humerus Fx Clinical Evaluation This makes supracondylar humerus fractures very unstable and prone to angular deformity. the olecranon fossa and coronoid fossa of the distal humerus create a very thin area of bone between the medial and lateral columns of the elbow.Pediatric Supracondylar Humerus Fx Anatomy During the hyperextension process, the olecranon process is forced against the weaker, immature metaphyseal bone of the distal humerus, producing the typical extension-type supracondylar fracture. This is often a period of maximum ligamentous laxity therefore, the elbow hyperextends when the child tries to catch himself or herself during a fall. most commonly peak in children who are around age 7 years. ![]() most common elbow fx in children, most common in children ![]() Pediatric Supracondylar Humerus Fx Etiology / Epidemiology / Natural History P- subsequent encounter for fracture with malunion K- subsequent encounter for fracture with nonunion G- subsequent encounter for fracture with delayed healing
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