![]() ![]() The anterior humeral line (in red on the right) does not intersect with the capitellum (in blue). (separation of both the anterior and posterior cortices).įigure 2: Lateral radiograph of a Type 2 supracondylar humerus fracture with a sail sign (outlined in yellow on the right) indicating an elbow effusion. Fractures can be classified as non-displaced, hinged and completely displaced Intersect the middle third of the capitellum distally, but will cross moreĪnteriorly, or not at all, in the setting of extension type fractures (FigureĢ). Radiographs will also demonstrate the direction and degree ofĪ line drawn down the anterior humerus canĪlso help to determine the severity of these injuries. These so-called “occult fracture” can be identified by the presence of a “posterior fat pad sign.” This sign is created when bleeding into the joint elevates the posterior fat pad off the bone (as seen in Figure 2). Occasionally, non-displaced fractures might not be easily visible. Plain radiographs are sufficient to diagnose supracondylar injuries. Skin color and capillary refill) is required. Examination of radial pulses and perfusion of the hand (including (owing to stretch or spasm) when it is tented over the distal humeral The brachial artery can have decreased flow The anterior interosseus nerve is mostĬommonly injured in extension-type injuries, and the ulnar nerve is most commonly The neurovascular exam at presentation is critical in children With elbow pain and swelling deformity and ecchymosis might be present with a more Extension-type fractures are far more common.Ĭhildren with supracondylar fractures present Supracondylar fractures can be described as either a flexion or extension injury type, meaning that the distal humerus fragment is flexed or extended relative to the proximal humeral shaft on a lateral radiograph. ![]() Usually occur in children between 4 and 8 years old after a fall on an Supracondylar (distal humeral metaphysis)įractures of the humerus are the most common elbow injury in children. Patients with posterior injuries canīe treated with open reduction and suture fixation of the SC joint or physeal Anterior SC injuries can be treated with anĪttempt at closed reduction, with open reduction and suture fixation reservedįor patients with symptomatic instability. ![]() Patients with asymptomatic anterior injuries Including the direction of dislocation and potential mediastinal compression. Often an axial CT scan will show the diagnosis more definitively, Order to detect subtle differences between the injured and un-injured SC Serendipity (40 degree cephalic tilt) radiographs of the bilateral clavicles in SC injuries can be identified with AP and May help to identify patients requiring more urgent treatment for posteriorĭislocation include dyspnea, dysphagia, stridor, pulse changes from theĬontralateral arm, venous congestion of the arm, and paresthesias. Posterior SC injuries are more subtleĪnd can be easily missed unless clinical vigilance is maintained. ![]() Near the SC joint with visible deformity. Figure 1: Consecutive axial CT scan images of the chest demonstrating posterior displacement of the left medial clavicle relative to the sternum (S=Sternum, RMC=Right medial clavicle, LMC= Left medial clavicle).Īnterior SC injuries can be felt as a bump ![]()
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