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Midhumerus fracture
14%
1/7
Scaphoid fracture
0%
0/7
Distal radius fracture
Distal ulnar fracture
Supracondular humerus fracture
71%
5/7
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This patient has a clinical presentation suggestive of a supracondylar humerus fracture with concomitant median nerve palsy. Patients are typically treated non-operatively with closed reduction or operatively with open reduction and internal fixation with pinning. Pediatric patients with falls on outstreched hands commonly present with supracondylar fractures of the humerus. These fractures are important to diagnose because they can often concur with neurovascular injuries. Specifically, the anterior interosseous nerve, a branch of the median nerve, can be stretched due to traction and lead to a palsy preventing thump opposition and making the "OK" sign. Additionally, injuries to vasculature can lead to permanent ischemic contracture. Barr present updated epidemiological data on supracondylar humerus fractures. Barr states that 41% of the patients requires operative treatment for prevention of permanent neural, vascular, and osseous abnormalities. Furthermore, the study also found that 58% of the fractures occurred during falls from either play equipment (38%) or during walking or running (21%). Lastly, significantly more fractures occurred during time off from school. Tomaszewski et al. reported on the complications of supracondylar humerus fractures and states that up to 15% of the patients can have concurrent neurovascular complications. They also state that of the patients that had displaced fractures, 11% have neural palsies and 8% had vascular complications. Ultimately, they note displacement and increased duration of symptoms was positively correlated with neurovascular complications. Illustrastion A shows a lateral radiograph of the right elbow with visible anterior and posterior fat pads, also called the "sail signs," due to their appearance. The anterior sail sign is more specific for an intra-articular fracture. These are suggestive of a supracondylar fracture even when it may not be clearly evident on radiographs, Incorrect Answers Answer 1: A midhumerus fracture is associated with a radial nerve palsy that results in wrist drop and sensory deficits in the posterior compartments of the arm. Answer 2: A scaphoid fracture is a common injury in falls and is typically characterized by pain over the anatomic snuffbox (dorsal aspect of the proximal thumb). Answer 3 and 4: Distal radial and ulnar fractures would present with crepitus below the elbow and would not results in extensive pain above the arm.
5.0
(4)
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