summary Supracondylar Fractures are one of the most common traumatic fractures seen in children and most commonly occur in children 5-7 years of age from a fall on an outstretched hand. Diagnosis can be made with plain radiographs. Treatment is usually closed reduction and percutanous pinning (CRPP), with the urgency depending on presence or absence of hand perfusion. Epidemiology Incidence extension type most common (95-98%) flexion type less common (<5%) Demographics occur most commonly in children aged 5-7years M = F Etiology Pathophysiology mechanism of injury fall on outstretched extremity Associated injuries neuropraxia anterior interosseous nerve (AIN) neurapraxia (branch of median n.) the most common nerve palsy seen with supracondylar humerus fractures radial nerve palsy second most common neurapraxia (close second) ulnar nerve palsy seen with flexion-type injury patterns nearly all cases of neurapraxia following supracondylar humerus fractures resolve spontaneously further diagnostic studies are not indicated in the acute setting vascular compromise (5-17%) rich collateral circulation can maintain circulation despite vascular injury ipsilateral distal radius fractures Anatomy Ossification centers of elbow age of ossification/appearance and age of fusion are two independent events that must be differentiated e.g., internal (medial epicondyle) apophysis ossifies/appears at age 6 years (table below) fuses at age ~ 17 years (is the last to fuse) +/- one year, varies between boys and girl Ossification Centers of the Elbow Ossification Center Years at ossification (appear on xray) Years at fusion (appear on xray) Capitellum 1 12 Radial Head 4 15 Medial epicondyle 6 17 Trochlea 8 12 Olecranon 10 15 Lateral epicondyle 12 12 Classification Gartland Classification (may be extension or flexion type) Characteristics Treatment Type I Nondisplaced Beware of subtle medial comminution leading to cubitus varus which technically means it is not a Type I Fracture Treated with cast immobilization x 3-4wks, with radiographs at 1 week Type II Displaced, in 1 plane Posterior cortex and posterior periosteal hinge intact Deformity is in the sagittal plane only Typically treated with CRPP Type III Displaced, in 2 or 3 planes Treated most commonly with CRPP or open reduction if needed Type IV Complete periosteal disruption with instability in flexion and extension Diagnosed with examination under anesthesia during surgery Treated most commonly with CRPP or open reduction if needed Medial comminution* Collapse of medial column, loss of Baumann angle Leads to varus malunion/classic gunstock deformity May or may not be associated with a sagittal plane deformity Treated with CRPP, often requires significant valgus force to reduce Flexion type Mechanism of injury is usually a fall on the olecranon Treated with CRPP More likely to require open reduction Presentation Symptoms pain refusal to move the elbow Physical exam inspection gross deformity swelling ecchymosis in antecubital fossa motion limited active elbow motion neuro exam neurovascular exam must be done before any reduction maneuver to be certain nerve or vascular injury is not iatrogenic (stuck in fracture site) Evaluate for AIN neurapraxia unable to flex the interphalangeal joint of the thumb and the distal interphalangeal joint of the index finger (can't make A-OK sign) median nerve injury loss of sensation over volar index finger radial nerve neurapraxia inability to extend wrist, MCP joints, thumb IP joint PIP and DIP can still be extended via intrinsic function (ulnar n.) vascular exam assess pulse present or absent by palpation present or absent by biphasic doppler pulse assess vascular perfusion well perfused warm pink poorly perfused cold pale arterial capillary refill > 2 seconds Imaging Radiographs recommended views AP and lateral x-ray of the elbow (really of the distal humerus) findings posterior fat pad sign lucency on a lateral view along the posterior distal humerus and olecranon fossa is highly suggestive of occult fracture around the elbow measurement displacement of the anterior humeral line anterior humeral line should intersect the middle third of the capitellum in children > 5 years old, and touches the capitellum in children in children <5. capitellum moves posteriorly to this reference line in extension type fractures and anteriorly in flexion type fractures alteration of Baumann angle Baumann's angle is created by drawing a line parallel to the longitudinal axis of the humeral shaft and a line along the lateral condylar physis as viewed on the AP image normal is 70-75°, but best judge is a comparison of the contralateral side deviation of >5-10° indicates coronal plane deformity and should not be accepted Angiography is typically not indicated Treatment Nonoperative long arm casting with less than 90° of elbow flexion indications warm perfused hand without neuro deficits and Type I (non-displaced) fractures Type II fractures that meet the following criteria anterior humeral line intersects the capitellum minimal swelling present no medial comminution technique typically used for 3 weeks repeat radiographs at 1 week to assess for interval displacement Operative closed reduction and percutanous pinning (CRPP) indications fracture pattern type II and III supracondylar fractures flexion type medial column collapse time to CRPP dictated by neurovascular status non-urgent (can wait overnight) indications warm perfused hand without neuro deficits some argue can treat an isolated AIN injury in non-urgent fashion technique splint in 30-40° elbow flexion, admit overnight for observation and elevation for elective surgery urgent (same day - do not wait overnight) indications pulseless, well-perfused hand sensory nerve deficits excessive swelling "brachialis sign" ecchymosis, dimpling/puckering antecubital fossa, palpable subcutaneous bone fragment indicates proximal fragment buttonholed through brachialis implies more serious injury, higher likelihood of arterial injury, significant swelling, more difficult closed reduction "floating elbow" ipsilateral supracondylar humerus and forearm/wrist fractures warrant timely pinning of both fractures to decrease the risk of compartment syndrome technique check vascular status after reduction if evidence of good distal perfusion admit for 48 hours of observation if not well perfused perform vascular exploration emergent (within hours) indications pulseless, poorly perfused hand technique check vascular status after reduction if well perfused admit and observe for 48 hours if not well perfused perform vascular exploration emergent vascular exploration and CRPP indications pulseless white hand (pale, cool, no doppler) following CRPP pulsatile and perfused hand that loses pulse following CRPP technique remove K-wires and reassess vascular status open exploration and reduction if vascular status does not improve open reduction, percutaneous pinning, +/- vascular exploration indications open fracture failed closed reduction more frequently required with flexion type fractures (compared to extension type) pulseless white OR pink hand that is unable to be reduced or there remains a gap gap might represent entrapped vascular structure Techniques Closed reduction and percutaneous pinning (CRPP) fixation closed reduction (extension-type) posteromedial displacement: forearm pronated with hyperflexion posterolateral displacement: forearm supinated with hyperflexion if pronation or supination does not work, try the opposite 2 lateral pins usually sufficient in type II fractures test stability under fluoroscopy technical pearls maximize separation of pins at fracture site engage both medial & lateral columns proximal to fracture engage sufficient bone in proximal & distal segments low threshold for 3rd lateral pin if concern about stability with first 2 pins pins should be inserted with elbow in flexion for extension-type injury and elbow in extension for flexion-type injury 3 lateral pins biomechanically stronger in bending and torsion than 2-pin constructs indications (where 2 lateral pins are insufficient) comminution type III and type IV (free floating distal fragment) no significant difference in stability between three lateral pins and crossed pins risk of iatrogenic nerve injury from a medial pin makes three lateral pins the construct of choice crossed pins biomechanically strongest to torsional stress higher risk of ulnar nerve injury (3-8%) highest risk if placed with elbow in hyperflexion as ulnar nerve subluxates anteriorly over medial epicondyle in some children reduce the risk of ulnar nerve injury by placing medial pin with elbow in extension use small medial incision (rather than percutaneous pinning) remove pins postop at 3 weeks Open Reduction with Percutaneous Pinning approach anterior approach if pulseless or median nerve injury a lateral or medial approach where periosteum is torn never posterior as posterior dissection can --> AVN soft tissue identify median nerve and brachial artery bone work confirm reduction with C-arm instrumentation 2 or 3 K-wires depending on the degree of stability Complications Pin migration most common complication (~2%) Infection occurs in 1-2.4% increased risk in age <4.5 years typically superficial and treated with oral antibiotics Cubitus valgus caused by fracture malunion can lead to tardy ulnar nerve palsy Cubitus varus (gunstock deformity) caused by fracture varus malunion, especially in medial comminution pattern is NOT caused by growth disturbance may represent a cosmetic issue with little functional limitations, however has been associated with posterolateral elbow instability can lead to tardy ulnar nerve palsy anterior nerve subluxation is most common cause nerve entrapment by scar tissue and fibrous bands of FCU second most common cause Recurvatum common with non-operative treatment of Type II and Type III fractures Nerve palsy from injury usually resolve, nerves rarely torn extension type fractures neuropraxia in 11% most commonly AIN mechanism = tenting of nerve on fracture, or entrapment in the fracture site flexion type fractures neuropraxia in 17% most commonly cause ulnar neuropraxia Vascular Injury radial pulse absent on initial presentation in 7-12% pulseless hand after closed reduction and pinning (3-4%) if perfusion is lost following reduction and pinning, pins should be removed immediately decision to explore is based on quality of extremity perfusion rather than absence of pulse arteriography is NOT indicated in isolated injuries role of doppler is unclear and does not change treatment Volkmann ischemic contracture rare, but dreaded complication may result from elbow hyperflexion casting increase in deep volar forearm compartment pressures and loss of radial pulse with elbow flexed >90° rarely seen with CRPP and postoperative immobilization in less than 90° Postoperative stiffness rare after casting or after pinning procedures remove pins and allow gentle ROM at 3-4 weeks postop resolves by 6 months literature does not support the use of physical therapy
Technique Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Supracondylar Humerus Fx Closed Reduction and Percutanous Pinning (CRPP) Lindsay Andras David L. Skaggs Pediatrics - Supracondylar Fracture - Pediatric Technique Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Supracondylar Humerus Fx Open Reduction and Internal Fixation Nina Lightdale Lindsay Andras Pediatrics - Supracondylar Fracture - Pediatric
QUESTIONS 1 of 60 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ19.195) A 5-year-old boy presents to the ER at 9 pm with the injury shown in Figure A after falling off the monkey bars. Examination reveals the ability to make an a-ok sign, cross his fingers, and give a thumbs up. He has no radial pulse and his hand is cold. The decision is made to proceed with closed reduction and percutaneous pinning. When should the procedure be performed? QID: 214097 FIGURES: A Type & Select Correct Answer 1 Urgently, within 6-8 hours 4% (53/1277) 2 First case the following morning (~6 am) 1% (9/1277) 3 8 hours after his last meal 0% (5/1277) 4 Emergently, as soon as the operating room allows 94% (1205/1277) 5 As a scheduled procedure the following day with a vascular surgeon present 0% (2/1277) L 1 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ18.13) For which of the following injuries should lateral pins be placed with the elbow in an extended position? QID: 212909 Type & Select Correct Answer 1 Fracture with the anterior humeral line intersecting the middle third of the capitellum 1% (16/1818) 2 Fracture with the supracondylar region of the humerus displaced anteriorly to the humeral shaft 75% (1368/1818) 3 Fracture with the supracondylar region of the humerus displaced posteriorly to the humeral shaft with an intact posterior periosteal hinge 7% (125/1818) 4 Fracture with the supracondylar region of the humerus with complete periosteal disruption and instability in flexion and extension 7% (134/1818) 5 Fracture with the supracondylar region of the humerus displaced posteriorly to the humeral shaft with a disrupted posterior periosteal hinge 9% (165/1818) L 2 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (OBQ18.20) An 8-year-old sustains the injury shown in Figure A after falling downstairs. He is able to cross his fingers, flex and extend the IP joint of his thumb, and has intact sensation. His fingers have a brisk capillary refill but there is no palpable or dopplerable pulse. Injury films are shown in Figure A. This patient should undergo: QID: 212916 FIGURES: A Type & Select Correct Answer 1 Emergent vascular exploration 3% (72/2120) 2 Open reduction and internal fixation 11% (232/2120) 3 Close monitoring for compartment syndrome perioperatively and urgent surgery 60% (1275/2120) 4 Closed reduction and casting 24% (517/2120) 5 Delayed surgical intervention to allow for soft tissue rest 0% (3/2120) L 3 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (OBQ18.44) Aaron and Randy are twin 8-year-old brothers who fall off a trampoline and sustain supracondylar humerus fractures that undergo closed reduction and percutaneous pinning. 6 weeks postoperatively Randy is placed into physical therapy for elbow range of motion while Aaron is not. In long-term follow up how will Randy's outcome compare to Aaron's? QID: 212940 Type & Select Correct Answer 1 Randy will have a decreased rate of heterotopic ossification 1% (16/2111) 2 Aaron will be less likely to have a cubitus varus deformity 1% (14/2111) 3 Randy will have superior functional an motion recovery compared to Aaron 4% (92/2111) 4 Randy will have improved motion but the functional recovery will be similar 6% (123/2111) 5 There will be no difference in functional and motion recovery 88% (1854/2111) L 1 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (OBQ18.66) A 7-year-old patient presents with right elbow swelling and deformity after falling off of a trampoline. Figures A and B demonstrate the injury radiographs. In the emergency department, the patient has a warm pink hand with a strong radial pulse and intact AIN motor function. The patient is taken to the OR the next morning for closed reduction and percutaneous pinning. After the fracture is reduced and the pins are placed, the patient's hand appears pale and cool with absent radial pulses. What is the next appropriate step? QID: 212962 FIGURES: A B Type & Select Correct Answer 1 Apply a splint and reassess pulses in the PACU 1% (16/1887) 2 Warm the extremity and reassess pulses 2% (37/1887) 3 Perform a doppler examination 4% (71/1887) 4 Remove the pins, re-displacement of the fracture, and reassess pulses 85% (1605/1887) 5 Perform an anterior exploration 7% (136/1887) L 2 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ18.219) A 7-year-old girl falls in the park and sustains the injury depicted in Figure A and B. The most commonly observed nerve injury would result in deficits in which of the following muscles? QID: 213115 FIGURES: A B Type & Select Correct Answer 1 Dorsal interossei 1% (26/1863) 2 Extensor digitorum communis 1% (27/1863) 3 Extensor pollicis longus 3% (65/1863) 4 Flexor pollicis longus 91% (1695/1863) 5 Palmar interossei 2% (31/1863) N/A Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ18.14) An 8-year-old male sustained the injury shown in Figures A-B. On physical examination, he is found to have a nerve deficit. Which of the following is the most likely nerve deficit and how should the nerve injury be managed after the fracture has been reduced and stabilized? QID: 212910 FIGURES: A B Type & Select Correct Answer 1 Anterior interosseous nerve (AIN); observation 90% (1962/2171) 2 AIN; neurolysis 1% (14/2171) 3 Median nerve; observation 6% (123/2171) 4 Median nerve; neurolysis 0% (9/2171) 5 Ulnar nerve; observation 2% (47/2171) L 1 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (OBQ17.41) A 7-year-old girl presents to the emergency room after a fall with right arm pain. She has full motor and sensory function. Her fingers are warm and pink with a capillary refill <3 seconds, and she is noted to have ecchymosis in her antecubital fossa. Radiographs are seen in Figures A and B. What is the most appropriate management plan? QID: 210128 FIGURES: A B Type & Select Correct Answer 1 Closed reduction, long arm casting, and discharge home 8% (146/1830) 2 Closed reduction, long arm casting, and admission for a 24-hour observation 13% (247/1830) 3 Closed reduction, percutaneous pin fixation, and discharge home 74% (1356/1830) 4 Closed reduction, percutaneous pin fixation, and admission for arteriography 3% (50/1830) 5 Open reduction with brachial artery exploration and admission for observation 1% (22/1830) L 2 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ16.86) A young child falls during gymnastics practice and sustains the isolated injury shown in Figure A. She is admitted to hospital for surgery. The prevalence of which complication is increased with this injury pattern? QID: 8848 FIGURES: A Type & Select Correct Answer 1 Compartment syndrome 73% (1282/1751) 2 Infection rates 0% (1/1751) 3 Open fracture 1% (21/1751) 4 Triceps avulsion 0% (5/1751) 5 Vascular injury 25% (432/1751) L 4 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ13.172) A 6-year-old sustains the injury shown in Figures A and B. The nerve most commonly affected by this fracture pattern innervates which of the following motor groups? QID: 4807 FIGURES: A B Type & Select Correct Answer 1 Intrinsics of the hand 5% (120/2629) 2 Wrist extensor 3% (83/2629) 3 Thumb extensor 2% (51/2629) 4 Thumb IP flexor 89% (2333/2629) 5 Digital extensor 1% (18/2629) L 1 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ13.163) A 7-year-old sustains the isolated injury shown in Figures A and B. On physical examination there is no evidence of soft tissue compromise and he is able to make an okay sign, give a thumbs up sign and cross his fingers. Which treatment will minimize complications? QID: 4798 FIGURES: A B Type & Select Correct Answer 1 Observation alone 0% (5/2098) 2 Closed reduction with casting in > 90 degrees of flexion 0% (9/2098) 3 Closed reduction with casting at 90 degrees of flexion 0% (10/2098) 4 Closed reduction and a percutaneous pinning construct using laterally based pins 91% (1900/2098) 5 Closed reduction and a percutaneous pinning construct using crossed pins 8% (159/2098) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ13.74) A 6-year-old presents with an elbow deformity after falling from the monkey bars. The skin is intact and no evidence of puckering is seen. The patient is neurovascularly intact. Representative radiographs of the injury are shown in Figures A and B. What is the optimal initial treatment for this injury based on the AAOS guidelines? QID: 4709 FIGURES: A B Type & Select Correct Answer 1 Observation alone 0% (3/2170) 2 Closed reduction and casting 1% (24/2170) 3 Primary open reduction and internal fixation 2% (43/2170) 4 Closed reduction with medial and lateral crossed pins 11% (235/2170) 5 Closed reduction with two or three lateral pins 85% (1848/2170) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ13.239) Figures A through E are injury radiographs of elbow injuries in children. A child complains of decreased sensation over the small finger acutely after an elbow injury. Which of the following radiographs is consistent with his injury? QID: 4874 FIGURES: A B C D E Type & Select Correct Answer 1 Figure A 85% (3673/4312) 2 Figure B 3% (141/4312) 3 Figure C 4% (187/4312) 4 Figure D 4% (153/4312) 5 Figure E 3% (129/4312) L 2 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ12.54) Following successful operative treatment, routine removal of hardware is recommended at 3-4 weeks for which of the following procedures? QID: 4414 FIGURES: A B C D E Type & Select Correct Answer 1 Figure A 1% (25/4849) 2 Figure B 2% (105/4849) 3 Figure C 3% (127/4849) 4 Figure D 94% (4552/4849) 5 Figure E 0% (17/4849) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ12.112) A 7-year-old patient presents with a fracture of her left supracondylar humerus and distal radius as evidenced in Figure A. She is neurovascularly intact and the skin shows no evidence of open wounds. Radiographs of the elbow show a displaced supracondylar fracture. Radiographs of the wrist show an extra-articular distal radius fracture with 25 degrees of dorsal angulation. This injury is most appropriately treated with which of the following? QID: 4472 FIGURES: A Type & Select Correct Answer 1 Closed reduction and casting of the supracondylar humerus fracture and distal radius fracture 1% (50/4694) 2 Closed reduction and pinning of both the supracondylar humerus fracture and distal radius fracture 52% (2442/4694) 3 Closed reduction and casting of the supracondylar humerus fracture and pinning of distal radius fracture 1% (62/4694) 4 Open reduction and pinning of both the supracondylar humerus and the distal radius fracture 6% (285/4694) 5 Closed reduction and pinning of the supracondylar humerus fracture and closed reduction and casting of distal radius fracture 39% (1830/4694) L 4 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (OBQ11.228) A 9-year-old-female presents with her parents who have concerns regarding the appearance of her elbow (Figure A). Her past medical history is significant for a supracondylar fracture treated in a cast when as a younger child. She has no pain with motion and has 0 to 120 degrees range of motion. She does not have functional limitations but her parents would like to improve the appearance of her elbow. Which of the following procedures will correct the cubitus varus but may result in a lateral prominence? QID: 3651 FIGURES: A Type & Select Correct Answer 1 Reverse V Osteotomy 1% (62/4171) 2 Medial opening-wedge osteotomy with medialization of the distal fragment 28% (1156/4171) 3 Step-cut osteotomy 6% (231/4171) 4 Dome Osteotomy 8% (329/4171) 5 Lateral closing-wedge osteotomy 57% (2362/4171) L 4 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (OBQ11.67) Which of the following elbow apophyses is the last to fuse during growth? QID: 3490 Type & Select Correct Answer 1 Capitellum 3% (114/4089) 2 External (lateral) epicondyle 45% (1856/4089) 3 Radial head 2% (75/4089) 4 Internal (medial) epicondyle 48% (1946/4089) 5 Trochlea 2% (85/4089) L 4 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ08.248) A child falls off of the monkey bars at school and sustains the left elbow injury shown in Figure A. What is a disadvantage of the fixation construct shown in Figure B compared to Figure C for this injury pattern? QID: 634 FIGURES: A B C Type & Select Correct Answer 1 Less biomechanical stability 4% (59/1512) 2 Higher incidence of compartment syndrome 0% (6/1512) 3 Higher chance of osteomyelitis 1% (14/1512) 4 Higher risk of iatrogenic injury to the ulnar nerve 93% (1406/1512) 5 Higher risk of iatrogenic injury to the anterior interosseous nerve 2% (26/1512) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (SAE07PE.16) A 5-year-old boy sustained an elbow injury. Examination in the emergency department reveals that he is unable to flex the interphalangeal joint of his thumb and the distal interphalangeal joint of his index finger. The radial pulse is palpable at the wrist, and sensation is normal throughout the hand. Radiographs are shown in Figures 6a and 6b. In addition to reduction and pinning of the fracture, initial treatment should include QID: 6076 FIGURES: A B Type & Select Correct Answer 1 repair of the posterior interosseous nerve. 1% (7/692) 2 repair of the median nerve at the elbow. 0% (3/692) 3 neurolysis of the anterior interosseous nerve. 1% (9/692) 4 observation of the nerve palsy. 96% (662/692) 5 immediate electromyography and nerve conduction velocity studies. 1% (5/692) L 1 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ07.179) A 7-year-old boy falls off the playground and sustains the injury shown in figure A. What motor deficit is associated with the nerve most commonly injured in this fracture pattern? QID: 840 FIGURES: A Type & Select Correct Answer 1 Weakness of the flexor digitorum profundus to the index finger 14% (390/2780) 2 Weakness of the extensor pollicis longus 6% (158/2780) 3 Wrist drop 6% (162/2780) 4 Weakness of the flexor pollicis longus 13% (370/2780) 5 Hand intrinsic weakness 60% (1680/2780) L 3 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (OBQ07.132) What is the advantage of medial and lateral crossed pins compared to two lateral pins in the treatment of supracondylar humerus fractures? QID: 793 Type & Select Correct Answer 1 Greater ultimate clinical arc of elbow motion 1% (9/1727) 2 Lower revision rate 1% (13/1727) 3 Lower incidence of ulnar nerve injury 2% (36/1727) 4 Greater experimental biomechanical stability 94% (1616/1727) 5 More anatomic fracture reduction 3% (47/1727) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ06.227) What is the etiology of cubitus varus following a supracondylar humerus fracture in a child? QID: 238 Type & Select Correct Answer 1 Overgrowth of the lateral physis 10% (260/2495) 2 Malreduction of the fracture 68% (1708/2495) 3 Growth arrest of medial physis 21% (512/2495) 4 Injury to the ulnar nerve 0% (5/2495) 5 Radial head dislocation 0% (3/2495) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (OBQ05.90) A 10-year-old boy sustained the injury shown in figure A while jumping off a trampoline. His hand is pulseless and cold. What is the next step in management? QID: 976 FIGURES: A Type & Select Correct Answer 1 Loose-fitting splint application and reassess in 1 hour 1% (8/1351) 2 Emergent closed reduction and pin fixation 90% (1213/1351) 3 Angiogram 1% (16/1351) 4 Open vascular exploration 8% (109/1351) 5 Forearm skeletal traction pin 0% (0/1351) L 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ04.140) The most common nerve injured in the fracture shown in Figure A innervates all of the following muscles EXCEPT? QID: 1245 FIGURES: A Type & Select Correct Answer 1 flexor digitorum profundus index finger 2% (30/1683) 2 flexor digitorum profundus middle finger 2% (27/1683) 3 flexor pollicis longus 3% (45/1683) 4 extensor pollicis longus 92% (1545/1683) 5 pronator quadratus 2% (31/1683) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ04.12) A 5-year-old boy sustains a type II (Gartland classification) supracondylar fracture which is treated with cast immobilization. Healing results in a mild gunstock deformity. Surgical treatment of this will most likely result in: QID: 123 Type & Select Correct Answer 1 improved functional outcome 7% (98/1428) 2 improved cosmesis 83% (1182/1428) 3 improved pain relief 1% (10/1428) 4 improved range of motion 8% (112/1428) 5 reduce non-union rates 1% (15/1428) L 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (OBQ04.225) A 8-year-old boy has a cubitus varus deformity of his left elbow after a supracondylar humerus fracture was treated in a splint. What is the most common cause of this deformity? QID: 1330 Type & Select Correct Answer 1 Malreduction causing malunion 72% (935/1306) 2 Medial epicondyle growth arrest 18% (238/1306) 3 Lateral condyle overgrowth 8% (106/1306) 4 Medial epicondyle avascular necrosis 1% (13/1306) 5 Unrecognized compartment syndrome 0% (3/1306) L 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic
All Videos (9) Podcasts (2) Surgical techniques - Opening a pediatric supracondylar humerus fracture Pediatrics - Supracondylar Fracture - Pediatric 1/14/2022 1530 views 5.0 (1) Pediatric supracondylar humerus fracture pinning -- Technique, Tips and Challenges Pediatrics - Supracondylar Fracture - Pediatric 1/14/2022 1106 views 5.0 (3) 2021 Orthopaedic Trauma & Fracture Care: Pushing the Envelope Supracondylar Humerus Fracture - Jessica McMichael, MD Jessica C. McMichael Pediatrics - Supracondylar Fracture - Pediatric A 3/3/2021 2176 views 3.8 (5) Pediatrics | Supracondylar Fracture Pediatrics - Supracondylar Fracture - Pediatric Listen Now 23:6 min 10/18/2019 2453 plays 4.6 (11) Question Session⎜Distal Humerus Fractures & Pediatric Supracondylar Fractures Orthobullets Team Pediatrics - Supracondylar Fracture - Pediatric Listen Now 29:44 min 11/11/2019 214 plays 5.0 (1) See More See Less
Nationwide Children's Hospital Pulseless Supracondylar Humerus Fracture with Nerve Palsy in 5F (C101941) Devon Myers Craig Smith Pediatrics - Supracondylar Fracture - Pediatric A 1/14/2022 15295 57 15 Stanford University Department of Orthopaedics Supracondylar Humerus Fx with Ulnar Nerve Palsy in 7M (C101438) Steve L. Frick Pediatrics - Supracondylar Fracture - Pediatric A 4/19/2020 10666 41 41 Children's Hospital Los Angeles Supracondylar Humerus Fx with Pulseless Hand in 9F (C101437) Lindsay Andras Pediatrics - Supracondylar Fracture - Pediatric A 4/19/2020 24152 67 12 See More See Less