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Pediatric supracondylar fracture of humerus
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Pediatric supracondylar fracture of humerus

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Contributors: David Sullo MD
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Synopsis

A common pediatric elbow injury involving a fracture of the distal humerus just above the epicondyles. Often due to a fall or traumatic injury, this is characterized by elbow pain, swelling, and decreased range of motion. Damage to ulnar, radial, and media nerves can cause loss of sensation, nerve paralysis, or motor impairment. It may be a mild and self-resolving neuropraxia, or lead to irreversible neurological or vascular damage. Vascular damage may also occur, and blood flow to the arm may be compromised due to increased compartmental pressures caused by swelling. Complications include Volkmann ischemic contracture and acute compartment syndrome, which require urgent intervention.

Severity of fracture ranges from milder type I stable nondisplaced fracture to the most complex type IV unstable multidirectional fracture. Management depends on the severity of injury, with treatments ranging from immobilization and pain medication (resources for opioid prescribing guidelines, as well as nonopioid alternatives, can be found here) to a variety of surgical procedures involving closed reduction, open reduction, percutaneous pinning, or k-wires. The most common complication following treatment is gun-stock deformity (cubitus varus) due to malunion during the healing process.

Codes

ICD10CM:
S42.426A – Nondisplaced comminuted supracondylar fracture without intercondylar fracture of unspecified humerus, initial encounter for closed fracture
S42.423A – Displaced comminuted supracondylar fracture without intercondylar fracture of unspecified humerus, initial encounter for closed fracture
S42.423B – Displaced comminuted supracondylar fracture without intercondylar fracture of unspecified humerus, initial encounter for open fracture
S42.426B – Nondisplaced comminuted supracondylar fracture without intercondylar fracture of unspecified humerus, initial encounter for open fracture

SNOMEDCT:
263193000 – Supracondylar fracture of humerus

Differential Diagnosis & Pitfalls

  • Fractures above and below the elbow (wrist, shoulder, clavicle) should be considered, especially in younger children who may not localize symptoms well.
  • Nursemaid's elbow should be considered in a child with an elbow injury with normal x-rays, as should a Salter-Harris type 1 injury.

References

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Last Updated: 11/09/2018
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Pediatric supracondylar fracture of humerus
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Pediatric supracondylar fracture of humerus (Supracondylar Fracture of Humerus) : Decreased range of motion, Developed rapidly in minutes or hours, Elbow pain, Joint swelling, Upper extremity edema
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