Supracondylar fracture teachmesurgeryteachmesurgery. Sickkids parent information sheet supracondylar humerus fracture without displacement. Supracondylar humeral fractures are the second most common fracture type in children. A free powerpoint ppt presentation displayed as a flash slide show on id. Complications of supracondylar fractures of the elbow. There are different kinds of breaks, from simple to serious. Of all femoral fractures, approximately 47% are distal femur fractures kolmert, 1982. Supracondylar nailing for difficult distal femur fractures. The nondominant extremity is most commonly affected. Supracondylar and intercondylar fractures of the femur.
Supracondylar humeral fractures are a common paediatric elbow injury, but are almost never seen in adults. Supracondylar fractures are most common in patients who suffer from osteoporosis or have had total knee replacement surgery. Study of surgical management of supracondylar femoral fracture by. Comparison of supraintercondylar and supracondylar femur. On the ap view, fracture lines can be seen through the metaphyseal bone of the distal humerus on either side of the olecranon fossa. The most commonly used classification for periprosthetic fractures of the distal femur was described by rorabeck and taylor level iv evidence. Pdf analysis of management of supracondylar femur fracture by.
The incidence of supracondylar fracture after total knee arthroplasty is approximately 1%. S70s79 injuries to the hip and thigh s72 fracture of femur 2020 icd10cm diagnosis code s72. Healed after 3 months and still asymptomatic at 2 years. The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint, while the distal part of the femur articulates with the tibia and kneecap forming the knee joint. Supracondylar soopruhkondehlahr femoral fracture also called distal distuhl femur fracture is when the thigh bone breaks at the knee. Type iii fractures can lead to adverse physical, social, and emotional consequences if they are not treated effectively. Radiographs of the elbow show a displaced supracondylar fracture. Deep ulcer, penetrating down to ligaments and muscle, but no bone involvement or abscess formation. This summary does not contain rationales that explain how and why these recommendations were developed nor does it contain the evidence supporting these recommendations. According to the fracture type, the system offers the option of a static locking mode with 3 plane fixation. Muller me, allgower m, perren s 1991 manual of internal fixation.
She is neurovascularly intact and the skin shows no evidence of open wounds. 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. Use of a supracondylar nail for treatment of a supracondylar fracture of the femur following total knee arthroplasty. This does not cause functional disability and should not be treated with physiotherapy. Periprosthetic fracture for hip periprosthetic fixationstandard is with plate or allograft or. 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. The aim of this study was to determine the prevalence and outcome of supracondylar fractures. If you have comments or questions, please contact jason kelecic, d. Dec 18, 2017 a supracondylar fracture is an injury to the humerus, or upper arm bone, at its narrowest point, just above the elbow.
It account for less than 7% of all femur fractures 1. Supracondylar fractures are a very common type of broken elbow seen in kids, especially ages 38 years old. Fractures in the supracondylar area characteristically deform with femoral shortening and posterior angulation and displacement of the distal fragment. Outcome of supracondylar femur fracture in adults managed. Effective management of periprosthetic fractures of the distal femur requires knowledge of both fracture fixation techniques and revision arthroplasty. Immediate weight bearing of comminuted supracondylar femur. 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. The lateral cortex of the femur has a 10 degree slope, and the medial cortex slopes 25 degrees. 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. Periprosthetic fractures of the distal femur most commonly present as fragility fractures associated with relatively minor trauma. Gartlands classification of supracondylar fracture of humerus. A, an anteriorposterior view shows a fairly subtle lucency through the distal humerus. 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. Supracondylar humeral fracture radiology reference article.
Open supracondylar fracture of femur short description. Evaluate the ipsilateral hip for dislocationinjury evaluate the popliteal fossa for hard signs of vascular injury. The osteotomy was created using parallel saw cuts at. We present our experience of management of distal femur fracture at our centre. The location of the fracture invariably alters management and, to that end, the majority of ppfs occur in the supracondylar region of the femur. These fractures usually occur in elderly patients with multiple comorbidities and osteoporotic bone. In addition to the t2 femoral nailing system, stryker developed the t2 supracondylar nail scn for the treatment of complex distal femoral fractures. Supraintercondylar fractures, supracondylar fractures, femur, condylar buttress plates. Supracondylar femur fractures above an insallburstein cck. A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint.
Supracondylar humerus fractures are widely considered the most common fracture of the elbow in children. Jan 15, 2012 arterial damage is sometimes associated with supracondylar fractures of the humerus. Supracondylar fractures are the most common type of upper arm injury in children. This injury can involve the cartilage on the base of the femur in the knee joint, and may increase the risk of developing knee arthritis later in life.
All readers of this summary are strongly urged to consult the full guideline and evidence. The management of distal femoral fractures following a total knee replacement can be complex and requires the equipment. The femur is the largest and strongest bone in the body, so it takes tremendous force to cause a fracture. The most common mechanism of injury is falling on an outstretched hand with the elbow in extension a small percentage occur from. Periprosthetic fractures around total knee arthroplasty. Supracondylar humeral fractures, often simply referred to as supracondylar fractures, are a classic pediatric injury which require vigilance as imaging findings can be subtle. Overview this condition is a break in the femur at the knee joint. Distal femur lecture orthopaedic trauma association. These injuries are often complicated by osteopenia of the distal femur secondary to stress shielding or osteolysis. Distal femur fractures indirect reduction not for articular surfaces direct visualization and reduction preserves softtissue envelope around metadiaphyseal. Pdf supracondylar fracture of the femur in children. Manipulation of supracondylar fracture of the elbow.
The omega3 supracondylar plate is also indicated for osteotomies of the proximal and the distal femur. Aug 17, 20 we therefore 1 evaluated union rate and fracture alignment on radiographs after elastic nailing of pediatric subtrochanteric and supracondylar femur fractures, 2 identified complications associated with the use of elastic nailing, and 3 determined risk factors for the development of complications. 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. Historically these fractures have been associated with poor outcomes secondary to the challenges presented by. Because of the anatomy of the distal femur, only surgical treatment is indicated to stabilize the fracture. 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. Oblique sc fracture of a patient with hxo prosthetic knee. Supracondylar fractures of the humerus sch are the most common fractures about the elbow in children that require operative stabilization. Although you may recognize this as a fracture, the degree of displacement appears minimal.
Fractures can range from a less severe, nondisplaced type i fracture to a more severe, displaced type iii fracture with no cortical contact. For nonosteoporotic bone and simple supracondylar fracture morphology. The femur is the largest and strongest bone in the body. Complicated multiple trauma injuries, associated pelvic and acetabular fractures, ipsilateral femoral shaft fractures, supracondylar and intercondylar fractures, may be better managed by utilizing retrograde femoral nailing techniques. The most common cause of a fracture is direct trauma to the leg from an automobile accident or a fall.
Treatment is usually closed reduction and percutanous pinning crpp, with the urgency depending on whether the hand remains perfused or not. Anterior notching of the femur during primary tka creates a stress riser in the supracondylar region and is a common cause of periprosthetic supracondylar fracture. Supracondylar fracture pediatric pediatrics orthobullets. Distal femoral fractures pose a difficult problem for the surgeon with significant complication rates and generally unsatisfactory results. All surgical techniques are available as pdf files. This is done either with manual traction or if neces. The aim of this study was to evaluate the recovery time of elbow range of motion after treatment of gartlands type ii and iii supracondylar fractures of distal humerus in children who attended a. If you continue browsing the site, you agree to the use of cookies on this website. T2 supracondylar nailing system operative technique indications the t2 scn system is indicated for. Pre op xray anteroposteriorap and lateral xray of thigh. Supracondylar fractures of the femur after total knee arthroplasty are an uncommon but highly challenging injury streubel et al.
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. Children more commonly suffer from this fracture than adults and it may cause serious complications if ignored. Supracondylar fracture wagner classification of diabetic foot ulcers. Wires may be placed to hold the fracture in position and or the arm may be placed in traction. Supracondylar fracture of the humerus is a common childhood injury to the elbow. The omega3 supracondylar plate is indicated for fractures of the distal femur which may include. Diagnosis and careful management of the fracture and arterial repair is crucial. Superficial ulcer involving the full skin thickness but not grade 2. Supracondylar distal femoral fractures may be classified as extraarticular, unicondylar, or bicondylar, and the fractures may have an intercondylar extension 1, 2.
The treatment of distal femoral fractures has evolved. Supracondylar femoral fracture central coast orthopedic. Open and closed femoral fractures pseudoarthrosis and correction osteotomy pathologic fractures, mi pendni g paholt ogc i fractures, and tumor resections supracondylar fractures, including those with intraarticular extension. The t2 scn system is the realization of superior biomechanical intramedullary stabilization using small caliber, strong and cannulated implants for internal fixation of the femur. All 30 patients of supracondylar femur fracture treated by lcp implantation were included in the study. Patients with supracondylar fractures will often have prolonged period months of inability to fully extend their elbow. Lateral and ap view of two year old girl with gartland type ii supracondylar fracture.
Femoral corrective osteotomy for malunited supracondylar. 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. Documentation of neurovascular status in supracondylar. Geriatric distal femur, or supracondylar, fractures are common fragility fractures. This type of fracture is referred to as a supracondylar humerus fracture. Supracondylar fractures of the femur sciencedirect.
The ulnar nerve with its posterior location is uncommonly involved with a typical extensiontype supracondylar fracture. 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. In more severe fractures with intercondylar involvement, one often sees. Supracondylar femur fracture adult distal femur trauma options. Supracondylar femur fractures orthopaedicsone articles. Current concepts 598 journal of the american academy of orthopaedic surgeons. They occur after a fall onto an outstretched arm, and they usually by falling off the monkeybars. Epidemiology simple supracondylar fractures are typically seen in yo. 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. Considering the possible complications involved including nerve deficit and compartment syndrome, documentation is crucial to good patient care. Jan 28, 2019 supracondylar fracture occurs commonly in distal humerus. 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. Pdf use of a supracondylar nail for treatment of a. Fixation of periprosthetic supracondylar femur the.
Supracondylar and intercondylar fractures of the femur springerlink. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. Management of distal femur fractures in adults orthopedic clinics. Supracondylar fracture types, treatment, classification. The incidence of distal femur fractures among all orthopedic injuries is less than. Figure 2 a 14yearold male with history of distal femur fracture treated with plaster cast case 1. Arterial damage accompanying supracondylar fractures of the.
Adjust the ruler until the distal end is at the desired nail insertion depth. Retrograde femoral nailing has expanded the use of intramedullary nails 1, 2. Krishnamoorty summary a retrospective study of 34 patients with supracondylar condylar fractures of the femur admitted to the alexandra hospital, singapore, from january 1979 to december 1983 wascarried out. The osteotomy was created using parallel saw cuts at 6 and 8. This 4yearold female fell from a couch onto her outstretched hand, sustaining a supracondylar humeral fracture.
A study on functional outcome of comminuted supracondylar. Dfn distal femoral nail surgical technique standard locking spiral blade locking. As a result, they are typically comminuted or involve osteoporotic bone. Kids broken elbow supracondylar fracture bone talks. With long forceps, hold the radiographic ruler 357. Displaced supracondylar fracture without intracondylar extension of lower end of right femur. Always check the web space between the 1st and 2nd toe. The anatomy of the distal femur explains the three major types of fracture. Supracondylar fractures are most common in patients who suffer from osteoporosis or have had total knee. Pdf analysis of management of supracondylar femur fracture by locking compression plate authors. An adequate ap view of the pelvis and ap and lateral views of the hip and whole femur are indicated for all these fractures. Oct, 2017 supracondylar femur fractures require anatomically stable internal fixation for best results, which usually necessitates surgical treatment. Supracondylar f e m u r fracture above a total k n e e arthroplasty is a difficult p r o b l e m w h i c h has b e e n successfully treated w i t h i n t r a m e d u l l a r y fixation with excellent results 18. Supracondylar fracture occurs commonly in distal humerus.
Risks of a manipulation of supracondylar fracture of the elbow there are risks and complications with this procedure. Sep 21, 20 supracondylar fracture humerus in children slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Outcome of supracondylar femur fracture in adults managed by. Supracondylar fractures result from a fall on an outstretched arm in up to 70 percent of patients. Supracondylar fractures of femur have a bimodal age distribution, with a high. The indications for physiotherapy after supracondylar humeral fractures in children are not clear in the literature, even in the presence of an active or passive limitation of elbow joint motion. The backslab and sling should be placed under figure 2. There is a bimodal distribution, with young patients with high energy trauma and elderly patients with lowenergy falls. The radial nerve lies posterolateral to the usual location of supracondylar fractures and, thus, is less commonly involved see fig. A distal portion of the medial condyle should be intact for the lag screw to gain adequate purchase.
This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. Ppt distal femur fractures powerpoint presentation. The most common mechanism is an indirect trauma on a bent knee, and more rarely direct trauma by crushing. The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint, while the distal part of the femur articulates with the tibia and kneecap forming. Feb 10, 2014 supracondylar femur fractures can cause peroneal nerve injury. It take a great deal of force to break the thigh bone. This condition is a break in the femur at the knee joint. 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. Raise the arm on a pillow when sitting or lying down loose fitting clothing, not through the sleeve. The fracture can range from a small crack to a full break that allows part of the bone to separate. Dfn distal femoral nail surgical technique depuy synthes 5 3 determine nail length position the image intensi. On lateral view the anterior humeral line is anterior to the middle of capitellum. If treated quickly, either by immobilizing with a cast or by surgery, the.
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