Treatment can be conservative and surgical. In daily clinical work, but also in literature, we face numerous methods of treating supracondylar fractures. Posttraumatic elbow contracture occurs as distinct consequences of these fractures and is characterized by varying degrees of restrictions of movement in the elbow ( 6, 7, 12, 15, 21, 22). Deterioration of function leads to injury of neurological and circulatory structures, while the major cosmetic problem is cubitus varus or valgus. They are divided into two basic groups: a) those that lead to deterioration of the lower extremities function, b) those who leave the cosmetic consequences. In the analysis of X-ray images is necessary to point out some characteristics of the angles, which are used to estimate the position of fragments: Baumann angle (Figure (Figure1), 1), AHL (anterior humeral line) (Figure (Figure2), 2), humerotrochlear angle (Figure (Figure3) 3) ( 3, 7, 12, 19).Ĭomplications arise as a result of trauma, iatrogenic during repositioning or during the surgery. Cubital region has three fat pads and during palpation of cubital region we should pay attention to the movement of fat pads, which with swelling of the region and palpatory tenderness indicate an occult fracture, but not visible on x-ray and without other clinical signs of fracture ( 2, 3, 12, 13).įor X-ray imaging are made standard projections: AP image with the extended elbow, forearm in neutral position lateral projection, the elbow in flexion if possible up to 90°. Clinical findings consist of examination, palpation, testing the functions and neurology-circulatory status, along with registration and exclusion of associated injuries and illness at admission. In history, essential is information on the mechanism of injury, as well as information about disorders and pain. It is based on: history, clinical examination and radiographs, whereas methods: ultrasound, CT, MRI, color-Doppler, angiography, EMG is useful as an additional diagnosis of multifragment fractures in suspected vascular injury and in assessing damage to nerve structures ( 3, 14, 17, 18, 19, 20, 21, 22). Diagnosis of fractures of the distal humerus in children is a clinical and radiological. The order of appearance is shown by mnemonic abbreviation: CRITOL (Capitulum, Radius, Internal or medial epicondyle, Trochlea, Olecranon, Lateral epicondyle). Ossification cores are gradually appearing in a specific order. It should be noted that at the time of birth the distal humerus is completely made of cartilage. There are six ossification centers in the elbow joint. If there are clinical signs of neurovascular lesions, or in case of open fracture, then this is classified as a fracture – type IV ( 1, 3, 5).įor diagnostic and therapeutic procedures with the trauma of the distal end of the humerus in children we should not forget the ossification map of this region. The most common is the Gartland classification (1959), which after radiographic analysis provides us guidance in selecting treatment options. As a criterion in all classification attempts are taken two features: the size of dislocation of the distal fractured fragment and the position of the fracture line. There are many classifications of supracondylar fractures. In most cases supracondylar humerus fractures in children resulting from falls on the outstretched hand, when the extensional type fracture occurs in approximately 97% of cases, while in 3% the flexion type occurs most often by fall on the bent elbow. ![]() The frequency with respect to gender shows that these fractures were twice as common in boys than in girls, while in relation to the side are more likely to occur in the left elbow on the nondominant side ( 3, 7, 18). Most of these fractures occur in children under the age of 10 years and usually between 5-8 years of age.įavorable conditions for the occurrence of fractures allow increased looseness of the collateral ligament laxity structures, immaturity of bone material in the humerus region and the specific relationship of bone structures in the elbow joint. Supracondylar humerus fractures are the most common fractures of the distal end of the humerus in children accounting for about 60% of all fractures in the elbow.įractures during growth period by its etiology, mechanism of injury and healing, differ significantly from the fracture at the adulthood ( 1, 3).
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