[29] Supracondylar Fractures of the Humerus

Question 1

Where are supracondylar fractures of the humerus common?

Answer 1

In children after FOOSH

Question 2

What are the clinical features of a supracondylar fracture of the humerus?

Answer 2

Elbow very swollen, and held semi-flexed

Question 3

What might the sharp edge of the proximal humerus do?

Answer 3

Injure the brachial artery, which lies anterior to it

Question 4

What are the classifications of supracondylar humerus fractures?

Answer 4

Extension

Flexion

Question 5

What is the more common type of supracondylar humerus fractures?

Answer 5

Extension

Question 6

What happens in an extension supracondylar humerus fracture?

Answer 6

The distal fragment of the humerus displaces posteriorly

Question 7

What happens in a flexion supracondylar humerus fracture?

Answer 7

The distal fragment displaces anteriorly

Question 8

What is involved in the specific management of a supracondylar humerus fracture?

Answer 8

Ensure there is no neurovascular damage

Restore the anatomy

Question 9

What should be done if the radial pulse is absent, or damage to the brachial artery is suspected in supracondylar humerus fractures?

Answer 9

You should urgently take to theatre for reduction, with or without on-table angiogram

Question 10

What nerve is vulnerable in supracondylar fractures of the humerus?

Answer 10

Median nerve

Question 11

What should be done if a supracondylar fracture of the humerus is non-displaced?

Answer 11

Flex the arm as fully as possible, and applya collar and cuff for 3 weeks

Question 12

What acts as a sling to stabilise the fracture in a non-displaced supracondylar humerus fracture?

Answer 12

Triceps

Question 13

What should be done if a supracondylar fracture of the humerus is displaced?

Answer 13

MUA and fixation with K wires and collar and cuff with arm flexed for 3 weeks

Question 14

What are the specific complications of supracondylar fractures of the humerus?

Answer 14

Neurovascular injury
Compartment syndrome
Gunstock deformity

Question 15

What neurovascular injury may occur in a supracondylar fracture of the humerus?

Answer 15

Brachial artery
Radial nerve
Median nerve, especially the anterior interosseous branch

Question 16

What does the median nerve supply?

Answer 16

The deep forearm flexors (FPL, lateral half of FDP, and pronator quadratus)

Question 17

What is the result of the potential for a supracondylar fracture of the humerus to cause compartment syndrome?

Answer 17

Should monitor closely during the first 24hrs

Question 18

What is an early sign of compartment syndrome caused by a supracondylar fracture of the humerus?

Answer 18

Pain on passive extension of the fingers (stretches the flexor compartment)

Question 19

How can compartment syndrome be managed when caused by a supracondylar fracture of the humerus?

Answer 19

Try extension of the elbow, however surgical management may be needed

Question 20

What might result from compartment syndrome in a supracondylar fracture of the humerus?

Answer 20

Volkmann’s ischaemic contracture

Question 21

What happens in Volkmann’s ischaemic contracture?

Answer 21

Fibrosis of the flexor muscles leads to a claw hand

Question 22

What causes a gunstock deformity?

Answer 22

Valgus, varus, and rotational deformities in the coronal plane do not remodel, leading to a cubitus varus (gunstock deformity)