Projetos

Review Article

Management of Supracondylar Humerus Fractures in Children: Current Concepts
Abstract
Joshua M. Abzug, MD Martin J. Herman, MD

Supracondylar humerus fractures are the most common elbow fractures in the pediatric population. Type I fractures are managed nonsurgically, but most displaced injuries (types II, III, and IV) require surgical intervention. Closed reduction and percutaneous pinning remains the mainstay of surgical management. Numerous studies have reported recent alterations in important aspects of managing these fractures. Currently, many surgeons wait until 12 to 18 hours after injury to perform surgery provided the child’s neurovascular and soft-tissue statuses permit. Increasingly, type II fractures are managed surgically; cast management is reserved for fractures with extension displacement only. Two to three lateral pins are adequate for stabilizing most fractures. Evolving management concepts include those regarding pin placement, the problems of a pulseless hand, compartment syndrome, and posterolateral rotatory instability.

From the Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD (Dr. Abzug), and The Orthopedic Center for Children, St. Christopher’s Hospital for Children, Philadelphia, PA (Dr. Herman). Dr. Herman or an immediate family member serves as a paid consultant to Lanx and serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons and the Pediatric Orthopaedic Society of North America. Neither Dr. Abzug nor any immediate family member has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article. J Am Acad Orthop Surg 2012;20: 69-77 Copyright 2012 by the American Academy of Orthopaedic Surgeons.

upracondylar fracture is the most common type of elbow fracture in children, accounting for 3% of all pediatric fractures.1,2 This fracture type