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