Supracondylar humeral fractures in children.
Operative fixation is indicated for most type-II and III supracondylar humeral fractures in order to prevent malunion. Medial comminution is a subtle finding that, if treated nonoperatively, is likely to lead to unacceptable varus malunion. Angiography is not indicated for a pulseless limb, as it delays fracture reduction, which usually corrects the vascular problem. A high index of suspicion is necessary to avoid missing an impending compartment syndrome, especially when there is a concomitant forearm fracture or when there is a median nerve injury, which may mask symptoms of compartment syndrome. Lateral entry pins have been shown, in biomechanical and clinical studies, to be as stable as cross pinning if they are well spaced at the fracture line, and they are not associated with the risk of iatrogenic ulnar nerve injury.
Childrens Orthopaedic Center, Childrens Hospital Los Angeles, 4650 Sunset Boulevard, MS 69, Los Angeles, CA 90027, USA.
SourceThe Journal of bone and joint surgery. American volume 90:5 2008 May pg 1121-32
Pub Type(s)Journal Article