Supracondylar Fracture - Pediatric Pathway Posted: 4/19/2020 ID: (C101438)

Supracondylar Humerus Fx with Ulnar Nerve Palsy in 7M

0%
PRESENTATION
2
0%
POLLS
10,666
0%
OUTCOMES
4
0%
VIDEOS
6
0%
EVIDENCE
41
0%
Comments
41
CASE DESCRIPTION
AGE 7 / Male
CC Right elbow pain
HPI This is a 7-year-old male who sustained a witnessed fall from the monkey bars and landed directly onto his right elbow. He had immediate pain and swelling to the right elbow. His mother brought him into the emergency department immediately for evaluation. He is evaluated by Orthopedics at 8pm, and his last PO (full meal) was at 7pm.
PMH Healthy, no significant past medical history
PE Focused examination of the right upper extremity reveals obvious swelling of the elbow with inability to tolerate any range of motion, posterior ecchymosis proximal to olecranon, and a medial elbow abrasion. There is no tenderness to palpation of the forearm or wrist. He is able to make a thumbs up and "ok" sign. He has difficulty crossing his 2nd and 3rd fingers over. Sensation is intact to the back of the thumb and finger pads of the index and middle fingers. Diminished sensation (feels "asleep") along ulnar border of the small finger is present. He has 2+ radial pulse with all fingers warm and well perfused.
Pre-procedure IMAGES:
https://upload.orthobullets.com/cases/101438/dbd896dd-aef6-471e-865d-a86f3cc86b33_picture1.jpg https://upload.orthobullets.com/cases/101438/74134711-36a7-4999-a3c7-ad766ac66ef0_picture2.jpg
POLLS
OB Community
1) In addition to the plain radiographs above, would you obtain any additional imaging to guide treatment?
Other
2) How would you classify this injury?
Other
3) How would you initially manage this injury?
Other
4) If you choose Operative management, assuming you saw the patient in the ER at 8 pm, and they ate a full meal at 7 pm, when would you perform surgery?
Other
5) If you choose Operative management, how would you setup the OR?
Other
6) If you choose Operative management, what would be your INITIAL surgical plan going into the OR?
Other
7) If you choose Attempt Closed reduction percutaneous pinning (CRPP), non-anatomic reduction in which of the following planes would most likely influence your decision to convert to open?
Other
8) If you choose Attempt Closed reduction percutaneous pinning (CRPP) and have an unsatisfactory reduction, WHEN would you make the decision to convert to open?
Other
9) If you choose Planned Open reduction percutaneous pinning (ORPP), what approach would you use?
Other
10) If you choose Attempt Closed reduction percutaneous pinning (CRPP) or Planned Open reduction percutaneous pinning (ORPP), what fixation construct would you use?
Other
11) If you choose to place Medial pins, what would be your preferred technique?
Other
12) If you choose Planned or Converted Open reduction percutaneous pinning (ORPP), considering the patient has a nerve palsy, would you explore and perform neurolysis?
Other
13) If you choose Planned or Converted Open reduction percutaneous pinning (ORPP), how long would you observe this patient in the hospital after surgery?
Other
14) If you choose Closed reduction percutaneous pinning (CRPP) or Open reduction percutaneous pinning (ORPP), when would you remove the pins?
Other
CASE OUTCOMES
PROCEDURE 1: Closed (Converted to Open) Reduction and Percutaneous Pinning of right supracondylar humerus fracture
Intra-procedure P1
https://upload.orthobullets.com/cases/101438/fec19034-2059-4f53-8bfa-4b96726cc8cb_picture4.jpg https://upload.orthobullets.com/cases/101438/972f775b-f630-4096-9749-f8bd83f1b11f_screen_shot_2020-04-20_at_4.43.18_am.jpg https://upload.orthobullets.com/cases/101438/acbb98ad-59da-4aac-8184-984f6a75f1f6_screen_shot_2020-04-20_at_5.13.58_am.jpg
Post-procedure P1
https://upload.orthobullets.com/cases/101438/293694c5-d5a2-494c-b62b-2401fc2697ce_screen_shot_2020-04-20_at_5.15.29_am.jpg
VIDEOS & PODCASTS (6)
EVIDENCE (41)
EXPERT COMMENTS