References

Allen SR, Hang JR, Hau RC Review article: paediatric supracondylar humeral fractures: emergency assessment and management. Emerg Med Australas. 2010; 22:(5)418-26

Ashton H Effect of inflatable plastic splints on blood flow. Br Med J. 1966; 2:(5527)1427-30

Beals RK The normal carrying angle of the elbow. A radiographic study of 422 patients. Clin Orthop Relat Res. 1976; 119:194-6

Bendall JC, Simpson PM, Middleton PM Effectiveness of prehospital morphine, fentanyl, and methoxyflurane in pediatric patients. PrehospEmerg Care. 2011; 15:(2)158-65

Borland ML, Jacobs I, Geelhoed G Intranasal fentanyl reduces acute pain in children in the emergency department: a safety and efficacy study. Emerg Med (Fremantle). 2002; 14:(3)275-80

Borland M, Jacobs I, King B A randomized controlled trial comparing intranasal fentanyl to intravenous morphine for managing acute pain in children in the emergency department. Ann Emerg Med. 2007; 49:(3)335-40

Christensen KS, Trautner S, Stockel M Inflatable splints: do they cause tissue ischaemia?. Injury. 1986; 17:167-70

Cole J, Shepherd M, Young P Intranasal fentanyl in 1-3-year-olds: a prospective study of the effectiveness of intranasal fentanyl as acute analgesia. Emerg Med Australas. 2009; 21:(5)395-400

Culp RW, Osterman AL, Davidson RS Neural injuries associated with supracondylar fractures of the humerus in children. J Bone Joint Surg Am. 1990; 72:(8)1211-5

Curry GJ A pneumatic leg splint. The Journal of the American Medical Association. 1944; 125:(14)966-8

In: Fleisher GR, Ludwig S Philadelphia: Lippincott Williams & Wilkins; 2010

In: Flynn J US: American Academy of Orthopaedic Surgeons; 2011

Neurovascular complications and functional outcome in displaced supracondylar fractures of the humerus in children. Injury. 2003; 34:(4)267-73

John SD, Wherry K, Swischuk LE Improving detection of pediatric elbow fractures by understanding their mechanics. Radiographics. 1996; 16:(6)1443-60

Lins RE, Simovitch RW, Waters PM Pediatric elbow trauma. Orthop Clin North Am. 1999; 30:(1)119-32

Mangwani J, Nadarajah R, Paterson JM Supracondylar humeral fractures in children: ten years’ experience in a teaching hospital. J Bone Joint Surg Br. 2006; 88:(3)362-5

Medical Developments International. 2011. http//tinyurl.com/6xhuv8j (accessed 25 October 2011)

MIMS online. 2011. http//tinyurl.com/3z6wju3 (accessed 25 October 2011)

Oakley E, Barnett P, Babl FE Backslab versus nonbackslab for immobilization of undisplaced supracondylar fractures: a randomized trial. PediatrEmerg Care. 2009; 25:(7)452-6

In: Ogden JA New York: Springer-Verlag; 2000

Omid R, Choi PD, Skaggs DL J Bone Joint Surg Am. 2008; 90:(5)1121-32

Pirone AM, Graham HK, Krajbich JI Management of displaced extension-type supracondylar fractures of the humerus in children. J Bone Joint Surg Am. 1988; 70:(5)641-50

Melbourne: The Royal Children's Hospital; 2011 http//tinyurl.com/3j2b48x

Reider BPhiladelphia: WB Saunders; 1999

Robb JE The pink, pulseless hand after supracondylar fracture of the humerus in children. J Bone Joint Surg Br. 2009; 91:(11)1410-2

In: Rockwood C, Bucholz R, Court-Brown C Philadelphia: Lippincott: Williams & Wilkins; 2006

Saunders M, Adelgais K, Nelson D Use of intranasal fentanyl for the relief of pediatric orthopedic trauma pain. Acad Emerg Med. 2010; 17:(11)1155-61

Simanovsky N, Lamdan R, Mosheiff R Underreduced supracondylar fracture of the humerus in children: clinical significance at skeletal maturity. J Pediatr Orthop. 2007; 27:(7)733-8

Sloan JP, Dove AF Inflatable splints-what are they doing?. Arch Emerg Med. 1984; 1:(3)151-5

Wang YL, Chang WN, Hsu CJ The recovery of elbow range of motion after treatment of supracondylar and lateral condylar fractures of the distal humerus in children. J Orthop Trauma. 2009; 23:(2)120-5

Wu J, Perron AD, Miller MD Orthopedic pitfalls in the ED: pediatric supracondylar humerus fractures. Am J Emerg Med. 2002; 20:(6)544-50

Zionts LE, Woodson CJ, Manjra N Time of return of elbow motion after percutaneous pinning of pediatric supracondylar humerus fractures. Clin Orthop Relat Res. 2009; 467:(8)2007-10

Prehospital management of paediatric supracondylar fractures

02 December 2011
Volume 3 · Issue 12

Abstract

Supracondylar humeral fractures are common in paediatric trauma. Prehospital management should focus on assessing and preserving the neurovascular integrity of the affected limb and on reducing pain. Secure immobilization and adequate analgesia are vital to achieving these aims. Currently, there is no consensus as to how to best immobilize the limb or to provide analgesia in the prehospital setting for a suspected supracondylar fracture. This article suggests an examination technique to assess the neurovascular status of the injured limb, and reviews some of the current methods of immobilization and analgesia used for prehospital management of supracondylar fractures.

Supracondylar humeral fractures account for approximately 60% of all fractures at the elbow, and up to 13% of all paediatric fractures overall (Omid et al, 2008). They occur most commonly between the ages of 5 and 8 years when the capsule and ligaments around the elbow have been shown to have greater tensile strength than the bone itself, which is weaker due to extensive remodelling that occurs at this age.

This results in an increased likelihood of fracture of the more vulnerable bone in the supracondylar region when force is applied across it (Beals, 1976; Lins et al, 1999; Ogden, 2000). They are very rare after 15 years of age, due to skeletal maturity, and occur more commonly in males than females (Beals, 1976; Lins et al, 1999).

Subscribe to get full access to the Journal of Paramedic Practice

Thank you for visiting the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.

What's included

  • CPD Focus

  • Develop your career

  • Stay informed