Pediatric emergency medicine trisk 3451 3451
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Injuries of the Elbow
Supracondylar Fractures
Goals of Treatment. Children with a mechanism and examination concerning for
supracondylar fractures should have early assessment of neurovascular status to
assess for neurologic or vascular compromise. Fractures associated with
neurovascular compromise should have early involvement of orthopedic surgery.
Management of supracondylar fractures is also aimed at preventing long-term
complications including poor functional outcomes from failure to achieve
anatomic alignment during reduction and immobilization.
CLINICAL PEARLS AND PITFALLS
A radiograph with a true lateral view of the elbow is imperative for
proper visualization of the anterior and posterior fat pads, and the
anterior humeral line (Figs. 111.15 and 111.16 ).
The presence of abnormalities of the fat pads or displacement of the
anterior humeral line on lateral view strongly suggests presence of
fracture (Fig. 111.17 ).
In patients with extensive soft tissue edema, elevation of the fat pads
may be obscured; therefore, relying on the clinical examination and
identifying the anterior humeral line on the lateral elbow radiograph are
important.
Fractures may be complicated by vascular injury to the brachial artery,
compartment syndrome, or neurologic injury to the median, radial, or
ulnar nerves.
Supracondylar fractures associated with ipsilateral forearm fractures
are particularly high risk for the development of ischemic injury even
when pulses and capillary refill are normal on examination.
Children whose distal humeral epiphyses have not yet ossified may
require arthrogram, ultrasound, or MRI to assess for possible
transphyseal or low supracondylar humerus fracture.
Current Evidence. Elbow fractures account for approximately 18% of all
pediatric fractures and are among the most problematic pediatric fractures in
terms of diagnosis, treatment, and complications. The most common mechanism
of injury resulting in a supracondylar fracture is FOOSH with resulting
