Supracondylar #

Question 1

Who does this affect?

Answer 1

• Paeds often
• Almost never seen in adults

Question 2

MOI

Answer 2

• FOOSH
• Elbow in extension

Question 3

Clinical features

Answer 3

• Recent fall/trauma
• Sudden onset, severe pain
• Gross deformity
• Swelling
• Reduced ROM
• Ecchymosis of anterior cubital fossa

Question 4

Nerve damage from supracondylar #

Answer 4

Carefully examine:
* Median nerve
* Anterior interosseous nerve
* Radial nerve
* Ulnar nerve

Question 5

Vascular damage from supracondylar # - what to look for

Answer 5

Check hands for:
* Cool temperature
* Pallor
* Delayed cap refill
* Absent pulses

Question 6

Differentials for supracondylar #

Answer 6

• Distal humerus or olecranon #
• Soft tissue injury
• Subluxation of radial head

Question 7

Investigations for supracondylar fractures

Answer 7

• X-ray - AP and lateral
• CT if comminuted or intra-articular extension is suspected

Question 8

Signs on x-ray of supracondylar fracture

Answer 8

• Posterior fat pad sign
• Displacement anterior humeral line - in children >5yrs this should intersect middle 1/3rd of capitulum

Question 9

Classification of supracondylar #

Answer 9

• Gartland classification

Question 10

Gartland classification

Answer 10

• Type 1 - undisplaced
• Type 2 - displaced with intact posterior cortex
• Type 3 - displaced in two or three planes
• Type 4 - displaced with complete periosteal disruption - diagnosed intraoperatively

Question 11

Management of supracondylar # - initial

Answer 11

• If NV compromise - immediate closed reduction
• In children, usually done in theatre and secured with K wire fixation

Question 12

Conservative management supracondylar #

Answer 12

• For type 1 # or minimally displaced type 2 Gartland
• Above elbow cast in 90 degrees flexion

Question 13

Surgical management supracondylar #

Answer 13

• Type II, III and IV = closed reduction and percutaneous K wire fixation
• If open # need OR and percutaneous pinning
• Ongoing vascular compromise despite reduction need vascular surgery review

Question 14

Complications supracondylar #

Answer 14

• Nerve palsies - anterior interosseous nerve most common, ulnar most common post op
• Malunion –> cubitus varus (gunstock) deformity, extended forearm deviates to midline
• Volkmanns contracture - vascular compromise, ischaemia and necrosis of flexor muscles of forearm - wrist and held permanently flexed, claw like