Supracondylar fracture

Question 1

Supracondylar Fractures of the Humerus

Answer 1

• Common in children (5-7 yo) after FOOSH with extended elbow

Question 2

Gartland classification of Supracondylar Fractures of the Humerus

Answer 2

I - non - displaced
II - displaced with intact posterior cortex
III - displaced with no cortical contact

Question 3

Mx of supracondylar fractures of the humerus

Answer 3

No displacement → flex the arm as fully as possible and apply a collar and cuff for 3wks

Displacement → immediate closed reduction - MUA + fixation with K-wires
+ collar and cuff with arm flexed for 3wks

Question 4

Presentation

Answer 4

Sudden onset severe pain

Elbow very swollen and held semi-flexed

Limited range of movement due to pain

Bruising of anterior cubital fossa

Sharp edge of proximal humerus may injure brachial artery which lies anterior to it

Question 5

Investigations

Answer 5

Xray

- posterior fat pad

Question 6

Complications of supracondylar fractures

Answer 6

Nerve palsy:

• The anterior interosseous nerve (okay sign) - initial injury
• Ulnar nerve palsy - postoperative complication

Malunion - cubitus varus deformity - “gunstock deformity”

Volkmann’s contracture

Question 7

Volkmann’s contracture

Answer 7

Occurs following vascular compromise.

Ischaemia and necrosis of the flexor muscles of the forearm - fibrosis and formation of contracture

Wrist and hand to be held in permanent flexion, as a claw-like deformity.

Question 8

MUA

Answer 8

Manipulation under anaesthesia