Outcome of retrograde intramedullary nailing and locking. This does not cause functional disability and should not be treated with physiotherapy. The majority of standard sized retrograde femoral nails are. The ulnar nerve with its posterior location is uncommonly involved with a typical extensiontype supracondylar fracture. Subtle signs on plain film radiograph for a supracondylar fracture include. Treatment is usually closed reduction and percutanous pinning crpp, with the urgency depending on whether the hand remains perfused or not. The incidence of supracondylar fracture after total knee arthroplasty is approximately 1%. Outcome of supracondylar femur fracture in adults managed. If you have comments or questions, please contact jason kelecic, d. Gartlands classification of supracondylar fracture of humerus. The most common cause of a fracture is direct trauma to the leg from an automobile accident or a fall. Distal femur fractures and its treatment with distal femur locking plate kanav padha, sandeep singh, abdul ghani, harish dang the incidence of distal femur fractures is around 37 100,000 patients per year.
Supracondylar fractures of the humerus are a common pediatric elbow injury that can be associated with neurovascular complications and skeletal deformity. Patients with supracondylar fractures will often have prolonged period months of inability to fully extend their elbow. On the ap view, fracture lines can be seen through the metaphyseal bone of the distal humerus on either side of the olecranon fossa. This is done either with manual traction or if neces. These fractures are more commonly seen in boys 4 these injuries are almost always due to accidental trauma, such as falling from a moderate height bedmonkeybars 4. Original study treatment of gustilo grade iii b supracondylar. 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. Supracondylar humeral fracture radiology reference. Supracondylar fracture pediatric pediatrics orthobullets. Barr reported a higher incidence of supracondylar humerus fractures during the vacations 2. This often resulted in a loss of independence, and in some instances. Pediatric supracondylar fractures of the distal humerus.
Comprehensive clinical evaluation is a necessity when children with these injuries present to the emergency department. Babst department of trauma surgery, cantonal hospital lucerne, lucerne, switzerland summary this paper describes current treatment strategies of distal femoral fractures as well as their evidence based rationale. 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. There are different kinds of breaks, from simple to serious. Epidemiology simple supracondylar fractures are typically seen in yo. Although you may recognize this as a fracture, the degree of displacement appears minimal. Complications of supracondylar fractures of the elbow. Always check the web space between the 1st and 2nd toe. Does time to surgery affect outcomes for periprosthetic. Read the supracondylar femoral nail for fractures proximal to a total knee replacement, injury on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Ppt distal femur fractures powerpoint presentation.
An analysis of varying pin size, number and lateral starting points has not previously been performed. She is neurovascularly intact and the skin shows no evidence of open wounds. Highly unstable complex c3type distal femur fracture. Fractures of the distal femur after total knee arthroplasty tka. Second, the standard implants used for other types of distal femoral fracture such as the condylar blade plate and supracondylar nails are not. Comparative study of functional outcome of supracondylar fractures of femur treated with distal femur locking compression plate with that of supracondylar. The third type is distal femoral fractures, also called supracondylar femur fracture, an injury to the thigh bone just above the knee joint. Supracondylar femoral fracture supracondylar refers to the part of the femur just above the knee joint. Supracondylar nailing of periprosthetic fractures above total knee. On lateral view the anterior humeral line is anterior to the middle of capitellum. Magellan femoral nail system the aos magellan femoral nail is targeted for use in intramedullary fixation of fractures of the femur. Evaluate the ipsilateral hip for dislocationinjury evaluate the popliteal fossa for hard signs of vascular injury. The toronto experience with the supracondylar fracture of the femur.
Ilizarov external fixation for severely comminuted supracondylar and intercondylar fractures of the distal femur. Pdf ilizarov external fixation for severely comminuted. A study of management of supracondylar femur fractures by. Rabin dreyer medical clinic created january 2006 revised august 2009. Nerve injury may develop with supracondylar fractures of the humerus and by misplaced injections. Simple supracondylar fractures are typically seen in younger children, and are uncommon in adults. This 4yearold female fell from a couch onto her outstretched hand, sustaining a supracondylar humeral fracture. Jan 28, 2019 supracondylar fracture occurs commonly in distal humerus. 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.
The loadtofailure test also showed that the supra condylar plate can withstand at least 4000 n in axial compression. Download full thesis topics for ms dnb orthopaedics degree. Distal femur fractures indirect reduction not for articular surfaces direct visualization and reduction preserves softtissue envelope around metadiaphyseal. Does time to surgery affect outcomes for periprosthetic femur fractures. For more information on subscription options, click below on the option that best describes. Twenty patients who had been treated with ilizarov external fixation for a gustilo grade iiib supra condylar fracture of the femur were functionally assessed 12 to. Help with complete thesis work available for download in all subjects. Supracondylar fracture occurs commonly in distal humerus. The supracondylar femoral nail for fractures proximal to a.
A free powerpoint ppt presentation displayed as a flash slide show on id. The mainstay of investigation for suspected supracondylar fractures is via plain film radiographs in both anteroposterior ap and lateral views of the elbow. Retrograde femoral nailing of periprosthetic fractures. Supracondylar femoral fracture after arthroscopic reconstruction of the anterior cruciate ligament. Dec, 2011 supracondylar fractures in children dept. Fractures in the supracondylar area characteristically deform with femoral shortening and posterior angulation and displacement of the distal fragment. We assumed that subcondylar plate with a locking design may have better biomechanical stability. 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. Supracondylar femur fracture after total knee replacement6 to 2. 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 femur is the largest and strongest bone in the body. Download thesis pdf files, complete thesis dissertation work. Distal femur lecture orthopaedic trauma association.
Supracondylar humeral fractures, often simply referred to as supracondylar fractures, are a classic pediatric injury which require vigilance as imaging findings can be subtle. However, because of the versatility and number of implants appropriate for fractures of the distal femur, other fracture patterns will be mentioned. The insallburstein constrained condylar knee femoral prosthesis. Fracture associated with implant placement fracture of the femoral. 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. Its unique screw configuration provides both versatility and diversity for the antegrade retrograde nail designs. The fixation to the distal femur is shorter in the supra. 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. Children more commonly suffer from this fracture than adults and it may cause serious complications if ignored.
Fractures of the distal femur proximal to total knee arthro. Dec 18, 2017 a supracondylar fracture is an injury to the humerus, or upper arm bone, at its narrowest point, just above the elbow. The primary focus of this chapter is on the fixation of combined supracondylar and intercondylar aoota 33c distal femoral fractures. Supracondylar femoral fracture central coast orthopedic. Supracondylar definition of supracondylar by the free. If age distribution is considered, in the 0 to 7 year age group, shf is easily the commonest fracture seen 28% 3. Oblique sc fracture of a patient with hxo prosthetic knee. Fractures of the distal femur whether supracondylar. Distal humerus anatomy medial epicondyle proximal to trochlea lateral epicondyle proximal to capitellum radial fossa accommodates margin of radial head during flexion coronoid fossa accepts coronoid process of ulna during flexion. Notching of the anterior femoral cortex during total knee arthroplasty has been implicated as a major factor leading to supracondylar femur fracture after total knee arthroplasty 3, 7. Open supracondylar fracture of femur short description. There is no clear evidence in the actual literature regarding which of the surgical approaches could bring about the best functional, cosmetic, and radiological outcomes, as well as fewer complications, when an open reduction and pinning of a severely displaced supracondylar humerus fracture is performed.
Supraintercondylar fractures, supracondylar fractures, femur, condylar buttress plates. A supracondylar fracture is an injury to the humerus, or upper arm bone, at its narrowest point, just above the elbow. Supracondylar femur fractures orthopaedicsone articles. Posteromedia l vs posterolateral biceps tendon insertion and axis of muscle pull lies medial to the shaft of the humerus during fall onto an outstretched supinated arm, the forces applied tend to disrupt the posteromedial periosteum first and displace the fragment posterolaterally. The nondominant extremity is most commonly affected. Understanding the anatomy, radiographic findings, complications, and management options associated with this fracture allow physicians to limit the morbidity associated with this injury. Raise the arm on a pillow when sitting or lying down loose fitting clothing, not through the sleeve. Supracondylar soopruhkondehlahr femoral fracture also called distal distuhl femur fracture is when the thigh bone breaks at the knee. Krishnamoorty summary a retrospective study of 34 patients with. In addition, a variety of distal femur fractures ranging from ao type a extraarticular metaphyseal, supracondylar, as well as intraarticular type c1 fractures can be stabilised. Discussion supracondylar femoral fractures around tkr pose a signi. 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. Biomechanical analysis of pin placement for pediatric. Distal femur fractures and its treatment with distal femur.
Chapter 53 fractures of the distal femur china quad diaries. Feb 10, 2014 supracondylar femur fractures can cause peroneal nerve injury. In these fractures, retrograde im nailing may be used and closed indirect fracture reduction is achieved by inserting the nail at a correct insertion point leaving. In more severe fractures with intercondylar involvement, one often sees. Supracondylar femur fractures above an insallburstein cck. Keatinganterior femoral notching and ipsilateral supracondylar femur fracture in total knee arthroplasty. Supracondylar fracture teachmesurgeryteachmesurgery. Technical note with a compatibility chart of the nail to femoral component. Use of a supracondylar nail for treatment of a supracondylar fracture of the femur following total knee arthroplasty. Neurovascular assessment can be difficult due to pain, anxiety and the young age of these patients. The radial nerve lies posterolateral to the usual location of supracondylar fractures and, thus, is less commonly involved see fig. Pdf use of a supracondylar nail for treatment of a. Supracondylar fractures result from a fall on an outstretched arm in up to 70 percent of patients.
Twenty synthetic humeri were sectioned in the mid olecranon fossa to simulate a supracondylar humerus fracture. The lateral cortex of the femur has a 10 degree slope, and the medial cortex slopes 25 degrees. Posterior fat pad sign lucency visible on the lateral view. Retrograde intramedullary nailing with a blocking pin technique for reduction of periprosthetic supracondylar femoral fracture after total knee arthroplasty. Background supracondylar fractures are associated with a high incidence of neurovascular complications. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. Supracondylar and intercondylar fractures of the femur.
These fractures usually occur in elderly patients with multiple comorbidities and osteoporotic bone. Reduction was achieved by manual traction and application of. Nail will not have an isthmic fit may need blocking pinsdrill bitsscrews percutaneous or open clamps nail will lock a fracture in a malreduced position as easily as it will. Intramedullary nailing of femoral and tibial shaft fractures. Retrograde intramedullary nailing of supracondylar femur. Outcome of supracondylar femur fracture in adults managed by. May 10, 2008 supracondylar fractures of the humerus are a common pediatric elbow injury that can be associated with neurovascular complications and skeletal deformity.
Supracondylar femur fracture above a wellfixed posterior cruciate substituting prosthesis may not allow the use of standard fixation methods because of the closed nature of the femoral box. Sickkids parent information sheet supracondylar humerus fracture without displacement. Supracondylar humeral fracture radiology reference article. Radiographs of the elbow show a displaced supracondylar fracture. In the 1960s treatment involved being treated in a traction bed for eight weeks, a fracture brace, then weight bearing might start again at 3 months from injury. 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.
Retrograde nails are an accepted treatment modality, via the intercondylar notch of the femoral prostheses. Supracondylar fractures in children final authorstream. Oct, 2017 supracondylar femur fractures require anatomically stable internal fixation for best results, which usually necessitates surgical treatment. The backslab and sling should be placed under figure 2. The anatomy of the distal femur explains the three major types of fracture.
A, an anteriorposterior view shows a fairly subtle lucency through the distal humerus. Supracondylar fractures are the most common type of upper arm injury in children. If the fractures around hip are excluded, 31% femoral fractures involve distal portion 1. In addition to the t2 femoral nailing system, stryker developed the t2 supracondylar nail scn for the treatment of complex distal femoral fractures. At the elbow, at the condylar groove, and at femoral stress fractures in adults view in chinese. Pdf supracondylar fracture of the femur in children. Pdf analysis of management of supracondylar femur fracture by. Lateral and ap view of two year old girl with gartland type ii supracondylar fracture. Comparison of supraintercondylar and supracondylar femur. Pdf analysis of management of supracondylar femur fracture by locking compression.
Current concepts 598 journal of the american academy of orthopaedic. Supracondylar fracture, femur, children discover the worlds research. Documentation of neurovascular status in supracondylar. Supracondylar fractures of the femur sciencedirect. We use your linkedin profile and activity data to personalize ads and to show you more relevant ads. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. Pre op xray anteroposteriorap and lateral xray of thigh. A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. Supracondylar fractures in children final authorstream presentation. Current concepts in fractures of the distal femur soucasny pohled na zlomeniny dolniho konce stehenni kosti b. The femur is the largest and strongest bone in the body, so it takes tremendous force to cause a fracture.
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