Supracondylar Humerus Fractures Workup

Updated: Aug 23, 2019
  • Author: Jiun-Lih Jerry Lin, MBBS, MS(Orth); Chief Editor: Jeffrey D Thomson, MD  more...
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Workup

Imaging Studies

Radiography

Adequate radiographs must be obtained to evaluate the fracture anatomy and to plan for surgical treatment. Radiography should include routine anteroposterior (AP) and lateral films, and possibly additional studies (eg, oblique views) as well. With comminuted bicolumn fractures (Arbeitsgemeinschaft für Osteosynthesefragen–Association for the Study of Internal Fixation [AO-ASIF] type C3), repeat films following initial reduction or with longitudinal traction maintained often prove helpful in further defining articular fracture fragments.

Silva et al studied the interobserver reliability (IEOR) and intraobserver reliability (IAOR) of the Baumann angle of the humerus (a simple, repeatable measurement that can determine outcome of supracondylar humerus fractures [SCHFs] in children). [10] This angle was measured by five observers on AP radiographs of 35 elbows that had sustained a nondisplaced supracondylar humerus fracture.

Ranges of differences in the measurement of the Baumann angles were established, and the percentage of agreement between observers was then calculated. [10] When the difference between observers in reported measurements of the Baumann angle was calculated to be within 7º of each other, at least four of the five observers agreed 100% of the time.

Heal et al evaluated the IEOR and IAOR of the Gartland radiographic classification for SCHFs in children. [11] AP and lateral radiographs of 50 SCHFs were graded on two occasions by four orthopedic surgeons according to the Wilkins modification of the Gartland classification, with the following results:

  • Type I fractures - Poor agreement
  • Type II fractures - Fair to moderate agreement
  • Type III fractures and the flexion group - Good to very good agreement
  • Good to very good intraobserver agreement

The authors concluded that surgeons should treat pediatric SCHFs on the basis of degree of displacement rather than the Gartland classification. [11]

Computed tomography

Computed tomography (CT) can also be helpful in surgical planning for complicated fractures. When concern exists about vascular injury, arteriography can be beneficial.

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Other Tests

In cases of neurologic injury, electromyography (EMG) generally is not helpful until approximately 3 months after injury, at which point it may serve as a helpful baseline for assessing progress.

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