Executive Editor: Fergal Monsell

General Editor: Chris Colton

Authors: Andrew Howard, Theddy Slongo

Pediatric distal humerus 13-M/3.1 III and IV

General considerations

This is a common fracture pattern. Complete fractures are usually displaced and are unstable following reduction because of the anatomy of the distal humerus.

Accurate, closed reduction stabilized with K-wires is the mainstay of treatment for these fracture patterns.

Olecranon screw traction can be useful in emerging healthcare settings if an image intensifier is not available.

Straight arm skin traction is also widely used in such settings. It requires no anesthesia, but the elbow is dependent, pain relief is less immediate, and the forearm is supinated rather than pronated. This will not be addressed in detail here.

These techniques are also applicable in sophisticated health care systems, as an alternative to an open approach.

External fixation is an alternative technique, which may be useful for fractures that are difficult to reduce, or patterns that are difficult to stabilize with K-wires.

ESIN is an alternative technique for fractures that can be reduced anatomically and where earlier motion is preferred.

Note: It is rare for a complete fracture to be stable enough to be treated with simple immobilization.

Timing of treatment

There is evidence that in nonurgent cases a delay in treatment of up to 2-3 days has no negative effect on healing or outcome.

Urgent cases include open supracondylar fractures, fractures with a pulseless perfused and/or white hand, dense neurological deficit with a severely displaced fracture.

The following points influence the timing of the treatment:

Appendix

Shortcuts

Decision support

Authors' added material

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v1.0 2016-12-01