9/2/2023 0 Comments Crppf supracondylar fracture![]() ![]() Randomised trials, prospective and retrospective case series, systematic reviews and an evolved professional consensus. Any indications for further review should be documented. Routine long-term follow up is not usually required. ![]() This case was submitted with supervision and input from: Soni C. The most common treatment for displaced fractures is CRPP or ORIF. Displaced fractures require urgent reduction, and some often require surgery within 48 hours of injury. The operating surgeon should determine and document the need for post-operative radiographs and anticipated time of wire removal. Supracondylar fractures occur in 6-8 years age group.Suspicion of compartment syndrome or deterioration of perfusion should prompt immediate vascular reassessment and intervention if required.When there is concern over iatrogenic nerve injury then a documented assessment with consultant input is required for consideration of nerve exploration before discharge. Monitoring of neurovascular status as described in 1 should continue post-operatively until the treating surgeon is confident there is no risk of vascular compromise or compartment syndrome.If the limb remains ischaemic after fracture reduction then exploration of the brachial artery is required with a surgeon competent to perform a small vessel vascular repair.Intraoperative assessment of satisfactory stability and clinical alignment should be performed and documented. 2mm diameter wires should be used, where possible, to achieve stability.When a medial wire is used, techniques to avoid ulnar nerve injury should be employed and recorded on the operation note.Crossed wires are associated with a lower risk of loss of fracture reduction, whereas divergent lateral wires reduce the risk of injury to the ulnar nerve. Surgical stabilisation should be with at least two K wires that engage in the cortex proximal to the fracture.A limb without clinical signs of ischaemia does not require brachial artery exploration whether or not the radial pulse is present. The majority of vascular impairments associated with supracondylar fractures resolve with fracture reduction.Surgical management should be provided urgently when there is an absent radial pulse, clinical signs of impaired perfusion of the hand and digits, open injury or evidence of threatened skin viability.Night-time operating is not necessary unless there are indications for urgent surgery which should be documented. Surgical management should be carried out on the day of injury.It should include the status of radial pulse, digital capillary refill time and the individual function of the radial, median (including anterior interosseous) and ulnar nerves. A documented assessment of the limb must be performed on presentation and immediately before surgical treatment.Fractures in adolescents may require adult treatment strategies. InclusionsĬhildren with a displaced supracondylar fracture of the humerus. They may be difficult to manage and can be associated with significant complications including nerve injury, vascular compromise, malunion and compartment syndrome. Note: An alternative method for reduction and fixation is the use of a lateral external fixation technique.Supracondylar fractures of the humerus are the most common elbow fractures seen in children. However, the modifications described below to the standard closed reduction technique will help in certain settings. No single closed reduction technique is going to be universally successful. If the fracture is not fixed with K-wires, the elbow would have to be immobilized in uncomfortable hyperextension. This allows the elbow to be brought back into a flexed position for cast immobilization. Once a good reduction has been obtained, it is best to stabilize the fracture with two K-wires. In principle, the maneuver of reduction must be one of hyperextension. In this type of fracture, the traditional closed reduction maneuver, as described for extension type supracondylar fractures, cannot be used as the traditional hyperflexion of the elbow and dorsal pressure of the distal fragment displaces the fracture farther.īe aware that, in the case of flexion type supracondylar fractures, the posterior periosteum is ruptured whereas the anterior periosteum is mostly intact. Closed reduction of flexion type supracondylar fracturesįlexion type supracondylar fractures account for less than 5% of all supracondylar fractures. ![]()
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