Summary: I am joined by Jeff Kay (PGY-4) to discuss paediatric supracondylar fractures. Learning objectives include (1) identify a supracondylar fracture based on radiographic signs, (2) describe the Gartland classification of supracondylar fractures, (3) summarize emergency assessment of associated neurovascular injuries, (4) discuss closed reduction maneuvers, casting position and CRPP pin configuration.
Timestamps:
1:15 - Background & Epidemiology
2:15 - Extension vs Flexion-type
2:30 - Anatomy
3:25 - Radiographic signs
6:35 - Initial Assessment
9:30 - Upper Extremity Neuro Assessment
11:00 - Gartland Classification
12:30 - Nonoperative Treatment (Casting)
14:15 - Deciding on Operative Management
15:30 - Closed Reduction Maneuvers
17:10 - Emergency Management
18:35 - CRPP Pin Configuration
19:30 - 3-Lateral vs Cross-pins (see images in Resources)
20:10 - CRPP Pin Configuration (cont - see JAAOS paper in Resources)
20:50 - Medial Pin
21:40 - Ulnar n. Protection
22:20 - Clinical Scenario
Resources:
Lateral Pins: https://www.orthopaedicsone.com/download/thumbnails/33687548/fig+9.jpg?version=1&modificationDate=1332443777000 vs Cross pins: https://www.cjhr.org/articles/2017/4/1/images/CHRISMEDJHealthRes_2017_4_1_43_196066_u9.jpg of Type 3 fractures
Management of Supracondylar Humerus Fractures (JAAOS, 2012): https://journals.lww.com/jaaos/Abstract/2012/02000/Management_of_Supracondylar_Humerus_Fractures_in.2.aspx
Gartland Classification: https://radiopaedia.org/articles/gartland-classification-of-supracondylar-humeral-fractures
OrthoBullets: https://www.orthobullets.com/pediatrics/4007/supracondylar-fracture--pediatri
