Pediatric Humeral Fracture
Original Editors Ashley Bohanan, Alisha Lopez, Hannah Duncan, Neha Palsule, Brittany Buenteo
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Search Strategy[edit | edit source]
add text here related to databases searched, keywords, and search timeline
Definition/Description[edit | edit source]
Pediatric humeral fractures can occur in several locations including the proximal humerus, shaft (diaphysis) of the humerus, or the distal humerus. Of these, the supracondylar fracture is the most common (Hart 2006) followed by lateral humeral condylar fractures (Tejwani 2011).
Proximal humeral fractures mechanism of injury (MOI) (Hart 2006)
- Fall or a direct hit to the proximal humerus (most common)
Lateral humeral condyle fractures MOI (Tejwani 2011)
- A fall onto the hand while in elbow flexion or on the inner posterior part of a flexed elbow, or forceful adduction of the forearm
- The push-off theory suggested by Milch hypothesized that this fracture is due to a force that is “directed upward and outward along the radius”
- The pull-off theory proposes that this fracture is an avulsion fracture
- In a study of pediatric cadaver elbows, Jakob et al stated that this fracture was the consistent result of only adducting the supinated forearm while the elbow was extended (Jakob 1975). The fracture line began on the lateral part of the condyle, which implies that the condyle was pulled off by the lateral collateral ligament and extensor muscles
- The most probable cause is a combination of the pull-off and push-off methods
Supracondylar Fractures MOI (Lord 2011)
- Hyperextension occurs during a fall onto the outstretched hand (FOOSH) with the elbow in extension, which indirectly puts force on the distal humerus and displaces it posteriorly; this can occur with or without a valgus or varus force. This ‘extension’ type of injury accounts for 95% of the cases.
o Children younger than 3 years usually incur this injury from falling from a height of less than 3 feet (i.e. couch or bed) (Ryan 2010)
o Older children sustain fractures from falls from greater heights off of playground equipment (i.e. swings, monkey bars) (Ryan 2010)
- If the hand is in a supinated position, then a posterolateral displacement occurs.
- If the hand is pronated, then a posteromedial displacement occurs (more common).
- Direct trauma or a fall onto a flexed elbow seldom occurs resulting in a ‘flexion’ type injury (5%) with anterior displacement.
Supracondylar fractures are classified based on how much displacement there is (Hart 2006). There are two commonly acknowledged classification systems for extension type supracondylar fractures include Gartland (established in 1959-Hart 2006) and the ensuing modification by Wilkins (Marquis 2008).
Gartland’s Original Classification (Marquis 2008, p. 63)
- Type I: undisplaced
- Type II: displaced with intact posterior cortex
- Type III: displaced, no cortical contact posteromedial or posterolateral
Modified Classification by Wilkins (Marquis 2008, p. 63)
- Type 1A: undisplaced fracture
- Type 2A: intact posterior cortex and angulation only
- Type 2B: intact posterior cortex, angulation and rotation
- Type 3A: displaced, no cortical contact, posteromedial
- Type 3B: displaced, no cortical contact, posterolateral
Epidemiology/Etiology[edit | edit source]
add text here
Characteristics/Clinical Presentation[edit | edit source]
add text here
Differential Diagnosis[edit | edit source]
add text here
Outcome Measures[edit | edit source]
add links to outcome measures here (also see Outcome Measures Database)
Examination[edit | edit source]
add text here related to physical examination and assessment
Medical Management
[edit | edit source]
add text here
Physical Therapy Management
[edit | edit source]
add text here
Key Research[edit | edit source]
add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)
Resources
[edit | edit source]
add appropriate resources here
Clinical Bottom Line[edit | edit source]
add text here
Recent Related Research (from Pubmed)[edit | edit source]
see tutorial on Adding PubMed Feed
Extension:RSS -- Error: Not a valid URL: Feed goes here!!|charset=UTF-8|short|max=10
References[edit | edit source]
see adding references tutorial.
