Executive Editor: Fergal Monsell

General Editor: Chris Colton

Authors: Andrew Howard, Theddy Slongo

Pediatric distal humerus 13-M/3.2 III and IV Closed reduction; K-wire fixation

Postoperative care

Supracondylar humeral fractures heal rapidly and often within 3-5 weeks.

Immobilization with the elbow in 90° flexion is recommended for fractures treated without pinning.

Immobilization with the elbow in 45°-90° flexion is recommended for fractures treated with intraosseous K-wires.

Analgesia, including ibuprofen and paracetamol, should be administered regularly, with additional oral narcotic medication for breakthrough pain.

Compartment syndrome

Compartment syndrome is a possible early postoperative complication that may be difficult to diagnose in younger children.

The child should be examined regularly, to ensure finger range of motion is comfortable and adequate.

Neurological and vascular examination should also be performed.

Increasing pain, decreasing range of finger motion, or deteriorating neurovascular signs should prompt consideration of compartment syndrome.

See also the additional material on postoperative infections .

Discharge care

When the child is discharged from the hospital, the parent/caregiver should be taught how to assess the limb.

They should also be advised to return if there is increased pain or decreased range of finger motion.

It is important to provide parents with the following additional information:

For the first few days, the elbow and forearm can be elevated on a pillow, until swelling decreases and comfort returns.

When the limb is comfortable, the child may optionally use a sling to support any splint if desired. Many children are more comfortable without a sling.

Follow-up x-rays

Control x-rays may be taken at one week following injury to assess fracture position and then at three weeks, out of any splintage, to assess fracture healing .

Removal of cast or splint

Fractures treated by closed reduction with splints, or casts, and fractures treated with closed reduction and percutaneous pinning should have the splintage removed 3 weeks after the injury date.

K-wire removal

Protruding K-wires can be removed in the clinic, without anesthesia.

A simple sling can be provided for comfort.

Recovery of motion

As symptoms recover, the child should be encouraged to remove the sling and begin active movements of the elbow.

The majority of elbow motion is recovered rapidly within the two months after the splint is removed. The older child may take a little longer.

Once the child is comfortable, with a nearly complete range of motion, he/she may resume noncontact sports incrementally. Resumption of unrestricted physical activity is a matter for judgment by the treating surgeon.

 

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v1.0 2016-12-01