Msallam _ supracondylar fractures.pdf 2025

Supracondylar fractures in children

1. Supracondylar
fractures
in children
Dr.Hasan msallam

3. ؟ﺮﺴﻜﻟا اﺬﻫ ﻰﻠﻋ ﺰﻛﺮﻧ اذﺎﻤﻟ Δ
ًًﺎﻴﺣاﺮﺟ ً ً ﻼﺧاﺪﺗ جﺎﺘﺤﺗ ﻲﺘﻟا ﻖﻓﺮﻤﻟا رﻮﺴﻛ ﺮﺜﻛأ ﻮﻫ :ًﺎًﻋﻮﻴﺷ ﺮﺜ ﻛ ﻷا .
(ﻖﻓﺮﻤﻟا ﺔﻘﻄﻨﻣ رﻮﺴﻛ ﻦﻣ %60 ﻲﻟاﻮﺣ) لﺎﻔ ﻃ ﻷا ﺪﻨﻋ
.(ﻲﺒﺴﻨﻟا ﺎﻬﻔﻌﺿو مﺎﻈﻌﻟا ﺔﻧوﺮﻣ ﺔﻤﻗ) تاﻮﻨﺳ 7-5 :ﺮﻤﻌﻟا ةورذ ·
.تﺎﻫﻮﺸﺗو ،ﺔﻴﺒﺼﻋ ،ﺔﻴﺋﺎﻋو :ةﺮﻴﺒﻛ ﺐﻗاﻮﻋ تاذ تﺎﻔﻋﺎﻀﻣ ·

عﻮﻨﻟا ﺔﺻﺎﺧ ،ًﺎًﻴﻋﺎﻌﺷو ًﺎًﻳﺮﻳﺮﺳ ًﺎًﻴﻔﺧ نﻮﻜﻳ نأ ﻦﻜﻤﻳ :ﻞﻠﻀﻣ ﺺﻴﺨﺸﺗ.
( type 1) لﺪﺒﺘﻤﻟا ﺮﻴﻏ
(Closed Reduction) ﻖﻠﻐﻤﻟا دﺮﻟا تارﺎﻬﻤﻟ ﻲﻘﻴﻘﺣ رﺎﺒﺘﺧا ·
.خﺎﻴ ﺳ ﻻﺎﺑ ﺖﻴﺒﺜﺘﻟاو

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①
②
③
④
: Anatomical PrinciplesΔ
ﺔﻴﺴ ﻧ ﻹا) ﻦﻴﺘﻤﻘﻠﻟا قﻮﻓ ،ﺪﻀﻌﻟا ﻢﻈﻌﻟ ةﺪﻴﻌﺒﻟا ﺔﻳﺎﻬﻨﻟا ﻲﻓ :ﺮﺴﻜﻟا ﻊﻗﻮﻣ
.(ﺔﻴﺸﺣﻮﻟاو
ﻖﻓﺮﻤﻟا ﺔﻄﺑرأ ةﻮﻗو ،ﺔﻘﻄﻨﻤﻟا هﺬﻫ ﻲﻓ ﻢﻈﻌﻟا ﻖﻗﺮﺗو ﺔﻗر :ﻒﻌﺿ طﺎﻘﻧ
.ﻢﻈﻌﻟا ةﻮﻘﺑ ﺔﻧرﺎﻘﻣ
:ةروﺎﺠﻤﻟا ﻰﻨﺒﻟا ﻊﻣ ﺔ ﻗ ﻼﻌﻟا
حﺎﻳﺰ ﻧ ﻻا ﻲﻓ ﺔﺑﺎ ﺻ ﻼﻟ ﺔﺿﺮﻋ ﺮﺜﻛأ :(Radial Nerve) يﺮﺒﻌﻜﻟا ﺐﺼﻌﻟا
.ﻲﺸﺣو-ﻲﻔﻠﺨﻟا
ﻲﻣﺎ ﻣ ﻷا ﻦﻴﻤﻈﻌﻟا ﻦﻴﺑ ﺐﺼﻌﻟاو (Median Nerve) ﻒﺻﺎﻨﻟا ﺐﺼﻌﻟا
ﻲﻓ ﺔﺑﺎ ﺻ ﻼﻟ ﺔﺿﺮﻋ ﺮﺜﻛأ :(Anterior Interosseous Nerve -AIN)
.ﻲﺴﻧإ-ﻲﻔﻠﺨﻟا حﺎﻳﺰ ﻧ ﻻا
.ﻲﻠﺧاﺪﻟا ﺖﻴﺒﺜﺘﻟا ءﺎﻨﺛأ ﺮﻄﺨﻠﻟ ضﺮﻌﻣ :(Ulnar Nerve) يﺪﻧﺰﻟا ﺐﺼﻌﻟا
وأ قﺰﻤﺘﻳ وأ دﺪﻤﺘﻳ نأ ﻦﻜﻤﻳ :(Brachial Artery) يﺪﻀﻌﻟا نﺎﻳﺮﺸﻟا
.ةﺪﻴﻌﺒﻟا ﺔﻴﻤﻈﻌﻟا ﺔﻌﻄﻘﻠﻟ ﻲﻔﻠﺨﻟا حﺎﻳﺰ ﻧ ﻻا ﻊﻣ ﻂﻐﻀﻨﻳ

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CRITOE - (Ossifiication Centers) ﻢﻈﻌﺘﻟا ﺰﻛاﺮﻣ Δ

.ﻢﻈﻌﺘﻟا ىﻮﻧ رﻮﻬﻇ ﺐﻴﺗﺮﺗ ﺔﻓﺮﻌﻣ :ﺊﻃﺎﺨﻟا ﺺﻴﺨﺸﺘﻟا ﺐﻨﺠﺘﻟ ﺔﻴﺒﻫﺬﻟا ةﺪﻋﺎﻘﻟا

(تاﻮﻨﺳ 1-2) Capitellum
(تاﻮﻨﺳ 3-4) Radial head
(تاﻮﻨﺳ 5-6) Internal Medial epicondyle
(تاﻮﻨﺳ 7-8) Trochlea
(تاﻮﻨﺳ 9-10) Olecranon
(تاﻮﻨﺳ 11-12) External Lateral epicondyle

9. (Mechanism of injury) ﺔﺑﺎ ﺻ ﻹا ﺔﻴﻟآ
①
②
(FOOSH - 95%) ةﺪﻤﻣ ﺪﻳ ﻰﻠﻋ طﻮﻘﺴﻟا (A
(Extension-Type)
fall on an outstretched hand
ﻲﻔﻠﺨﻟا حﺎﻳﺰ ﻧ ﻻا
posteromedial displacement 75%
posterolateral displacement 25%

:( Flixon-tupe ) (%5) ﻲﻨﺜﻣ ﻖﻓﺮﻣ ﻰﻠﻋ طﻮﻘﺴﻟا (B
ﻲﻣﺎ ﻣ ﻷا حﺎﻳﺰ ﻧ ﻻا
.ﺮﺜﻛأ تﺎﻔﻋﺎﻀﻣ ﻊﻣ ﻖﻓاﺮﺘﻣو ردﺎﻧ

11. Clinical) ﺺﺤﻔﻟاو يﺮﻳﺮﺴﻟا ﺮﻫﺎﻈﺘﻟا
Presentation & Exam
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:مﺎﻌﻟا ﻲﻜﻴﻨﻴﻠ ﻛ ﻹا ضﺮﻌﻟا


(Severe Pain) ﺪﻳﺪﺷ ﻢﻟأ

.(Swelling) مرﻮﺗ

"S فﺮﺣ" ﻞﻜﺷ ﻰﻠﻋ (Deformity) هﻮﺸﺗ

.(Shortening) ﺮﺼﻗ

(Pseudoparalysis) ﺔﻛﺮﺤﻟا ﻦﻣ فﻮﺨﻟا

(S-Shaped Deformity)

12. S-Shaped Deformity

13. ﻲﺋﺎﻋﻮﻟا ﻲﺒﺼﻌﻟا ﺺﺤﻔﻟا:ﻢ ﻫ ﻷا ﺺﺤﻔﻟا
Neurovascular assessment
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:يرﺎﺒﺟإو ﺖﺑﺎﺛ هءاﺮﺟإ
:(Vascular) ﻲﺋﺎﻋﻮﻟا ﺺﺤﻔﻟا

و (Radial) يﺮﺒﻌﻜﻟا ﺾﺒﻨﻟا ﺲﺟ :(Pulses) ﺾﺒﻨﻟا
.(Ulnar) يﺪﻧﺰﻟا
.ئراﻮﻃ ﺔﻟﺎﺣ ﻮﻫ "ﺾﺒﻧ ﻼﺑ"

:ﻢﻴﻴﻘﺗ :(Perfusion) ﺔﻳوﺮﺘﻟا
ء ﻼﺘ ﻣ ﻻا ةدﺎﻋإ ﻦﻣز ، (Temperature) ، ( Color)
(Capillary Refiill Time - CRT) يﺮﻌﺸﻟا

15. Gartland Classification
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رﺎﻴﻌﻤﻟا (Gartland Classifiication) ﺪ ﻧ ﻼﺗرﺎﻏ ﻒﻴﻨﺼﺗ ﺪﻌﻳ
قﻮﻓ ﺪﻀﻌﻟا رﻮﺴﻛ ﻲﻓ لﺪﺒﺘﻟا ﺔﺟرد ﻒﺻﻮﻟ ﻲﻤﻟﺎﻌﻟا ﻲﺒﻫﺬﻟا
لﺎﻔ ﻃ ﻷا ﺪﻨﻋ ﺔﻤﻘﻠﻟا
لﺪﺒﺘﻟا هﺎﺠﺗاو ﺔﻴﻔﻠﺨﻟا ةﺮﺸﻘﻟا لﺎﺼﺗا ىﺪﻣ ﻰﻠﻋ ﺪﻤﺘﻌﻳ ﺚﻴﺣ
مﺪﻋو ﺮﺴﻜﻟا ةﺪﺷ ﺪﻳﺪﺤﺘﻟ ﺔﻴﺒﻧﺎﺠﻟا ﺔﻴﻋﺎﻌ ﺷ ﻹا رﻮﺼﻟا ﻲﻓ
.راﺮﻘﺘ ﺳ ﻻا
ﺔﻴﺠﻴﺗاﺮﺘ ﺳ ﻻا رﺎﻴﺘ ﺧ ﻻ ﻲﺴﻴﺋﺮﻟا يدﺎﺷ ر ﻹا ﻞﻴﻟﺪﻟا ﻞﻜﺸﻳ
ﺔﻴ ﺟ ﻼﻌﻟا

19. Clinical and Radiological
Diagnosis
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: Clinical HistoryΔ
- FOOSH :(Mechanism of Injury) ﺔﺑﺎ ﺻ ﻹا ﺔﻴﻟآ
ةدوﺪﻤﻣ ﺪﻳ ﻰﻠﻋ طﻮﻘﺴﻟا
ةرﺪﻘﻟا مﺪﻋ ،يرﻮﻓ مرﻮﺗ ،دﺎﺣ ﻢﻟأ :(Symptoms) ضاﺮ ﻋ ﻷا
ﻖﻓﺮﻤﻟا ﻚﻳﺮﺤﺗ ﻰﻠﻋ
Physical ExaminationΔ
م ﻼﻳإ ، (S_Shaped) فﺮﻄﻟا هﻮﺸﺗ ، ﺔﻣذو.
.ﻂﺴﺒﻟاو ﻒﻄﻌﻟا ﻲﻓ ةﺪﻳﺪﺷ ﺔﻳدوﺪﺤﻣ ،

20. Neurological ExaminationΔ
Wrist) ﻊﺑﺎ ﺻ ﻷاو ﻢﺼﻌﻤﻟا ﻂﺴﺑ :(Radial Nerve) يﺮﺒﻌﻜﻟا ﺐﺼﻌﻟا .
(Extension
ﺔﺑﺎﺒﺴﻟاو مﺎﻬ ﺑ ﻹا ﻦﻴﺑ ﺐﻳﺮﻘﺘﻟا :(Median Nerve) ﻒﺻﺎﻨﻟا ﺐﺼﻌﻟا ·
(OK Sign)
Finger) ﻊﺑﺎ ﺻ ﻷا ﺪﻋﺎﺒﺗ :(Ulnar Nerve) يﺪﻧﺰﻟا ﺐﺼﻌﻟا ·
(Abduction
ﺪﻌﺑو ﻞﺒﻗ ﻲﺒﺼﻋ ﻞﻠﺧ يأ ﻞﻴﺠﺴﺗ :(Documentation) ﻖﻴﺛﻮﺘﻟا ·
ج ﻼﻌﻟا

22. :Vascular ExaminationΔ

(Pulse ) ﺾﺒﻨﻟا (1

:(Capillary Refiill Time) ﻲﺋﺎﻋﻮﻟا ﻦﻣﺰﻟا (2
ﺔﻴﻧﺎﺛ 2 > ﻲﻌﻴﺒﻄﻟا

(Color and Temperature) فﺮﻄﻟا ءفدو نﻮﻟ (3

24. Δ Radiographic
Views :
AP view:AP view:
ﺎﻳاوﺰﻟاو ، ﻲﺒﻧﺎﺠﻟا لﺪﺒﺘﻟا ﻢﻴﻴﻘﺗ

Lateral viewLateral view :
ﻂﺨﻟاو ، ﻲﻔﻠﺨﻟا لﺪﺒﺘﻟا ﻢﻴﻴﻘﺗ
ﻲﻣﺎ ﻣ ﻻا

25. What to look for in (Ap view) :
: (Baumann angle)نﺎﻣﻮﺑ ﺔﻳواز (1

.ﺔﻗﺪﺑ نﺎﻣﻮﺑ ﺔﻳواز ﺪﻳﺪﺤﺘﻟ ﻖﻓﺮﻤﻠﻟ ﻲﻘﻴﻘﺣ AP طﺎﻘﺳإ ﻰﻠﻋ لﻮﺼﺤﻟا مﺰﻠﻳ _
.نارود نوﺪﺑ ىﻮﺘﺴﻤﻟا ﺲﻔﻨﺑ ﺪﻋﺎﺴﻟاو ﺪﻀﻌﻟا نﻮﻜﻳ نأ :ﻲﻘﻴﻘﺣ AP ـب دﻮﺼﻘﻤﻟا _

(full extension) ﻖﻓﺮﻤﻠﻟ ﻞﻣﺎﻛ ﻂﺴﺑ طﺮﺘﺸﻳ ﻻ ،ىﺮ ﺧ ﻷا ﺔﻴﻘﻓﺮﻤﻟا ﺎﻳاوﺰﻟا ف ﻼﺨﺑ _
.ﻂﺴﺒﻟا تﺎﺟرد ﻦﻣ ﺔﺟرد يﺄﺑ AP ـلا ةرﻮﺻ ﻖﻴﻘﺤﺗ ﻦﻜﻤﻳ يا ،

:(α) نﺎﻣﻮﺑ ﺔﻳواز ـ
ﺪﻀﻌﻠﻟ ﻲﻟﻮﻄﻟا رﻮﺤﻤﻟا ﻦﻴﺑ ﻞﻜﺸﺘﺗ
/ lateral condyle) ﺔﻴﺸﺣﻮﻟا ﺔﻌﻄﻘﻠﻟ ﺔﻴﺷﺎﺸﻤﻟا ﺔﺤﻴﻔﺼﻟا ﺮﺒﻋ مﻮﺳﺮﻣ ﻢﻴﻘﺘﺴﻣ ﻂﺧو
.(capitulum

°81 – 64 :ﻲﻌﻴﺒﻄﻟا ىﺪﻤﻟا ـ
°72≈ :ﺔﻄﺳﻮﺘﻤﻟا ﺔﻤﻴﻘﻟا

.لﺎﻔ ﻃ ﻷا ﺪﻨﻋ ﺔﻳﺪﻀﻌﻟا ﺔﻤﻘﻠﻟا قﻮﻓ رﻮﺴﻜﻟ ﻖﻴﻗﺪﻟا ّّدﺮﻟا ﻲﻓ ةﺪﻋﺎﺴﻤﻠﻟ ﺔﻤﻬﻣ ةادأ ـ

27. : Metaphyseal–Diaphyseal Angle (2

وأ ﺮﺴﻜﻟا ﺪﻌﺑ (varus/valgus) ﻲﺒﻧﺎﺠﻟا ﻞﻴﻤﻟا ﺔﻳواز ﻢﻴﻴﻘﺘﻟ مﺪﺨﺘﺴﺗ _
.ﺖﻴﺒﺜﺘﻟا ﺪﻌﺑ

29. What to look for in ( Lateral
view):
Anterior Hemural line(1
Fat pad sign (2
Shaf-Condylar angle(3
Tear drop (4

34. Complications
.A: Early Complications
: Brachial Artery Injury (1
.ﺪﻳﺪﺷ ﻢﻟأ ،بﻮﺤﺷ ،ﺪﻴﻟا ةدوﺮﺑ ،يﺮﺒﻌﻜﻟا ﺾﺒﻨﻟا ناﺪﻘﻓ :تﺎ ﻣ ﻼﻌﻟا
.يرﻮﻓ ﻲﺣاﺮﺟ فﺎﺸﻜﺘﺳا ﺾﺒﻨﻟا ﺪﻌﻳ ﻢﻟ اذإ .ﺮﺴﻜﻠﻟ يرﻮﻓ در :ءاﺮ ﺟ ﻹا ·
:(Compartment Syndrome) ﺰﻴﺤﻟا ﺔﻣ ز ﻼﺘﻣ (2
:ﺔﺴﻤﺨﻟا P ـلا :تﺎ ﻣ ﻼﻌﻟا ·
(ﺪﻳﺪﺷ ﻢﻟأ) Pain ·
(بﻮﺤﺷ) Pallor ·
(ﻞﻤﻨﺗ) Paresthesia ·
(ﻞﻠﺷ) Paralysis ·
(ةﺮﺧﺄﺘﻣ ﺔ ﻣ ﻼﻋ - ﺾﺒﻨﻟا بﺎﻴﻏ) Pulselessness ·
.(Fasciotomy) ﺐﻠﻄﺘﻳ ﻲﺣاﺮﺟ ئرﺎﻃ :ءاﺮ ﺟ ﻹا ·

35. : Nerve Injury(3
: Radial nerve (A
مﺎﻬ ﺑ ﻹا ﻦﻴﺑ ﺪﻴﻟا ﺮﻬﻇ ﻲﻓ رﺪﺧ :ﻲﺴﺤﻟا .
.ﺔﺑﺎﺒﺴﻟا و مﺎﻬ ﺑ ﻻا
**wrist drop ** :ﻲﻛﺮﺤﻟا ·

36. B) AIN (Anterior
Interosseous
Nerve) :
ﻰﻠﻋ ةرﺪﻘﻟا مﺪﻋ .
sign" )OK ﻖﻓاﻮﻣ" ﻞﻤﻋ
(sign

37. C) Median nerve :

38. D) Ulnar nerve :
ﻲﻓ رﺪﺧ :ﻲﺴﺤﻟا .
.ﺮﺼﻨﺒﻟاو ﺮﺼﻨﺨﻟا

ﻲﻓ ﻒﻌﺿ :ﻲﻛﺮﺤﻟا ·
،ﺪﻴﻟا ﺔﻀﺒﻗ
**claw hand **
.(ﺔﻴﺒﻠﺨﻤﻟا ﺪﻴﻟا)

39. : Late Complications(B
Stiffness(1
(gunstock” deformity) Cubitus Varus Deformity(2
ﺐﻟﺎﻐﻟا ﻲﻓ ﺔﻔﻴﻇﻮﻟا ﻒﻌﻀﻳ ﻻ ،ﻲﻠﻴﻤﺠﺗ هﻮﺸﺗ

40. Management
A) Close reduction & Splint OR Cast
B) Surgery:
_CRPP(closed reduction and percutaneous pinning)
_ORIF(open reduction and internal fixation)

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:(Conservative management) ﺔﻈﻓﺎﺤﻣ ﺔﺠﻟﺎﻌﻤﻟا
ﻖﻓﺮﻣ قﻮﻓ Splint Or Cast
.Elbow fllexion 60–90° ﻒﻄﻌﺑ ﻖﻓﺮﻤﻟا
.عﻮﺒﺳأ ةﺪﻤﻟ كﺮﺘﻳ
:عﻮﺒﺳأ ﺪﻌﺑ
.Above elbow cast : (Not displaced) ﺮﺴﻜﻟا نﺎﻛ اذإ
.ﻊﻴﺑﺎﺳأ 4–3 :ﺖﻴﺒﺜﺘﻟا ةﺪﻣ
.تﺎﺒﺜﻟا ﻦﻣ ﺪﻛﺄﺘﻠﻟ ﺖﻴﺒﺜﺘﻟا ﺪﻌﺑ ﺔﻌ ﺷ ﻷﺎﺑ ﺔﻌﺑﺎﺘﻣ
type I

42. Type l

43. type II
:Closed reduction + Fixation
:Fixation
1) Splint then cast
2) CRPP (ﻲﺒﻫﺬﻟا رﺎﻴﻌﻤﻟا)

44. Type ll

45. Type lll & lV:
1) Closed reduction + Percutaneous Pinning (CRPP)
(ﻲﺒﻫﺬﻟا رﺎﻴﻌﻤﻟا)
2) Open reduction with internal fixation (ORIF).
: لﺎﺣ ﻲﻓ ﻪﻟ ﺄﺠﻠﻧ ـ
. Irreducible fracture by closed reduction
.Severe swelling
.open fracture
.Late diagnosis

46. Pinning fixation:
_ 2 lateral pins - divergent or parallel
_ 2 crossed pins
_ 3 lateral pins
_ 2 lateral and 1 medial pins
3 lateral pins > 2 crossed pins > 2 lateral divergent > 2 lateral paralle
Stability:

48. The pin spread at the fracture site should be more than
3/1 of the bone diameter.

49. You must be cautious when using a medial pin for fixation

50. Thank you