[29] Supracondylar Fractures of the Humerus Flashcards
Where are supracondylar fractures of the humerus common?
In children after FOOSH
What are the clinical features of a supracondylar fracture of the humerus?
Elbow very swollen, and held semi-flexed
What might the sharp edge of the proximal humerus do?
Injure the brachial artery, which lies anterior to it
What are the classifications of supracondylar humerus fractures?
Extension
Flexion
What is the more common type of supracondylar humerus fractures?
Extension
What happens in an extension supracondylar humerus fracture?
The distal fragment of the humerus displaces posteriorly
What happens in a flexion supracondylar humerus fracture?
The distal fragment displaces anteriorly
What is involved in the specific management of a supracondylar humerus fracture?
Ensure there is no neurovascular damage
Restore the anatomy
What should be done if the radial pulse is absent, or damage to the brachial artery is suspected in supracondylar humerus fractures?
You should urgently take to theatre for reduction, with or without on-table angiogram
What nerve is vulnerable in supracondylar fractures of the humerus?
Median nerve
What should be done if a supracondylar fracture of the humerus is non-displaced?
Flex the arm as fully as possible, and applya collar and cuff for 3 weeks
What acts as a sling to stabilise the fracture in a non-displaced supracondylar humerus fracture?
Triceps
What should be done if a supracondylar fracture of the humerus is displaced?
MUA and fixation with K wires and collar and cuff with arm flexed for 3 weeks
What are the specific complications of supracondylar fractures of the humerus?
Neurovascular injury
Compartment syndrome
Gunstock deformity
What neurovascular injury may occur in a supracondylar fracture of the humerus?
Brachial artery
Radial nerve
Median nerve, especially the anterior interosseous branch
What does the median nerve supply?
The deep forearm flexors (FPL, lateral half of FDP, and pronator quadratus)
What is the result of the potential for a supracondylar fracture of the humerus to cause compartment syndrome?
Should monitor closely during the first 24hrs
What is an early sign of compartment syndrome caused by a supracondylar fracture of the humerus?
Pain on passive extension of the fingers (stretches the flexor compartment)
How can compartment syndrome be managed when caused by a supracondylar fracture of the humerus?
Try extension of the elbow, however surgical management may be needed
What might result from compartment syndrome in a supracondylar fracture of the humerus?
Volkmann’s ischaemic contracture
What happens in Volkmann’s ischaemic contracture?
Fibrosis of the flexor muscles leads to a claw hand
What causes a gunstock deformity?
Valgus, varus, and rotational deformities in the coronal plane do not remodel, leading to a cubitus varus (gunstock deformity)
