The Gartland classification has been used extensively to describe these injuries and is useful for identification of type 1 (undisplaced) and type 3 (completely displaced) fractures ( Gartland 1959). There are two commonly used classifications for describing the radiographic appearance of supracondylar fractures. Five per cent are flexion type injuries, where the elbow has been over‐bent and the elbow has been pushed forwards in relation to the humerus these are typically more unstable and more challenging to treat. Ninety‐five per cent of supracondylar fractures are extension‐type injuries, where the elbow has been over‐extended and the elbow moves backwards in relation to the humerus. When describing the local vascular status of the arm of a child with a supracondylar fracture, a three‐class system is typically used as described in Omid 2008.Ī class 3 injury is the most worrying, with a white, pulseless hand with delayed capillary refill time indicating severe vascular compromise. In displaced supracondylar fractures the reported rate of vascular injury ranges from 5% to 31% and nerve injury at presentation from 5% to 15% ( Barr 2014 Del Valle‐Hernández 2017 Farnsworth 1998 Houshian 2011). Clinical findings along with fracture pattern and the level of displacement on X‐ray can be used to predict the risk of complications. To identify and try to prevent these serious complications, an adequate history and examination to identify nerve or blood vessel compromise is essential when assessing children with this fracture. Cubitus varus is commonly unsightly and can be associated with reduced function of the limb. Children may end up with an arm with cubitus varus (the forearm pointing towards the midline), cubitus valgus (excessive bending away from the midline) or rotational abnormalities. This can arise as a result of malunion (the bone healing up in the wrong position post injury), or as a result of altered growth around the elbow. The other significant complication relates to the alignment of the arm. The last mentioned is a very rare complication where there is excessive swelling in the arm, increasing pressure in the arm and compressing the blood vessels this can cause permanent damage to the muscles and nerves if not identified and treated promptly. The major blood vessels and nerves in the arm can be damaged during the injury, the operation or as a result of compartment syndrome. However, complications of this injury can occur as a result of the initial injury or as a result of problems during surgery. Successful treatment of a supracondylar elbow fracture in a child leads to normal function with no lasting symptoms. Open fractures require urgent surgical treatment to reduce the risk of serious infection ( Holt 2018). Only 1% of supracondylar fractures are open, with an associated wound providing a direct route for contamination of the bone ends the remaining 99% are closed (with no open wound). The typical mechanism of injury is a fall onto an outstretched hand or a direct fall onto a flexed (bent) elbow ( Farnsworth 1998). However, a study of children in Hong Kong reported a higher incidence in boys equating to a ratio of 17 boys to 10 girls ( Cheng 1999). Several epidemiological studies have reported little gender difference in the incidence of these injuries ( Barr 2014 Farnsworth 1998 Holt 2018 Houshian 2011). Supracondylar elbow fractures can occur throughout childhood, but are most common in children between 5 and 6 years of age ( Barr 2014 Holt 2018 Houshian 2011). Supracondylar fractures are the most common form of elbow fracture in children with an annual incidence between 60 and 177 per 100,000 children ( Holt 2018 Houshian 2011) these fractures are rare in adults. The condyles of the humerus are the two rounded prominences at the end of the bone that are part of the elbow joint. A supracondylar fracture is a break in the humerus (upper arm bone) occurring up to two inches (5 cm) above the elbow joint.
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