Humerus Supracondylar

In cases of suspected supracondylar fracture careful handling of the joint is required. An older child may be less distressed if the lateral elbow is imaged in the same position as shown above for an erect lateral projection of the humerus. 

Fractures in the region of the elbow can be particularly difficult to diagnose and delineate accurately. Ultrasound has been shown to be a useful adjunct to plain radiography, particularly if clinical suspicion is high and radiographs are indeterminate (Davidson et al. 1994 Markowitz et al. 1992 Vocke-Hell and Schmid 2001). With supracondylar fractures of the humerus, ultrasound may demonstrate the fracture line in association with a joint effusion and elevation of the fat pads (Figs. 4.5,4.6). 

Fig. 4.5. Longitudinal image of the distal humerus in a child following trauma. There is distension of the elbow joint (arrowheads) with loss of cortical continuity (arrow) in the supracondylar region. The image has been rotated to allow comparison with the radiograph (see Fig. 4.6)...

Approximately 65%-75% of fractures in children occur in the upper limh, principally due to their tendency to fall on an outstretched hand. Most fractures occur at the distal radius with less than 10% of them occurring at the elbow. Of the elbow injuries, the vast majority are at the distal end of the humerus with the supracondylar fracture being the commonest, followed by lateral condyle fractures. 

Foster DE, Sullivan JA, Gross RH (1985) Lateral humeral condylar fractures in children. J Pediatr Orthop 5 16-22 Gartland JJ (1959) Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet 109 145-154... 

Karlsson J, Thorstien T, Thorleifsson R, Arnason H (1986) Entrapment of the median nerve and brachial artery after supracondylar fractures of the humerus in children. Arch Orthop Trauma Surg 104 389-391... 

Kilfoyle RM (1965) Fractures of the medial condyle and epi-condyle of the elbow in children. Clin Orthop 41 43-47 Lee SS, Mahar AT, Miesen D, Newton PO (2002) Displaced pediatric supracondylar humerus fractures biomechanical analysis of percutaneous pinning techniques. J Pediatr Orthop 22 440-443... 

Leet AI, Young C, Hoffer MM (2002) Medial condyle fractures of the humerus in children. J Pediatr Orthop 22 2-7 Lyons JP, Edwin A, Hoffer MM (1998) Ulnar nerve palsies after percutaneous cross-pinning of supracondylar fractures in children s elbows. J Pediatr Orthop 18 43-45 Lyons ST, Quinn M, Stanitski CL (2000) Neurovascular injuries in type III humeral supracondylar fractures in children. Clin Orthop 376 62-67... 

Milch H (1964) Fractures and fracture dislocations of humeral condyles. J Trauma 4 592-607 Mirsky EC, Karas EH, Weiner LS (1997) Lateral condyle fractures in children evaluation of classification and treatment. J Orthop Trauma 11 117-120 Mostafavi HR, Spero C (2000) Crossed pin fixation of displaced supracondylar humerus fractures in children. Clin Orthop 376 56-61... 

O Hara LJ, Barlow JW, Clarke NM (2000) Displaced supracondylar fractures of the humerus in children. Audit changes practice. J Bone Joint Surg Br 82 204-210 Prathapkumar KR, Garg NK, Bruce CE (2006) Elastic stable intramedullary nail fixation for severely displaced fractures of the neck of the radius in children. J Bone Joint Surg Br 88 358-361... 

Rogers LF, Malave S Jr, White H, Tachdjian MO (1978) Plastic bowing, torus and greenstick supracondylar fractures of the humerus radiographic clues to obscure fractures of the elbow in children. Radiology 128 145-150 Roposch A, Reis M, Molina M, Davids J, Stanley E, Wilkins K, Chambers HG (2002) Supracondylar fractures of the humerus associated with ipsilateral forearm fractures in children a report of forty-seven cases. J Pediatr Orthop 21 307-312... 

Subasi M, Kesemenli C, Necmioglu S et al (2002) Supracondylar process of the humerus. Acta Orthop Belg 68 72-75 Szkudlarek M, Court-Payen M, Strandberg C et al (2001) Power Doppler ultrasonography for assessment of synovitis in the metacarpophalangeal joints of patients with rheumatoid... 

From the supracondylar area of the lateral aspect of the humerus. 

Longus The lower third of the supracondylar ridge of humerus. Brevis The lateral epicondyle of humerus. 

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