Supracondylar fracture Flashcards
What is the peak age of incidence?
5-7 years
Almost never seen in adults
What is the most common mechanism of injury?
FOOSH with the elbow in extension
Why is a thorough assessment essential?
Due to the close proximity of surrounding neurovascular structures
How do patients typically present?
Following recent fall or direct trauma
Sudden onset severe pain
Reluctance to move affected arm
What is seen on examination?
May be signs of gross deformity, swelling, limited range of elbow movement
Ecchymosis of anterior cubital fossa
What neurovascular structures are in close proximity?
Brachial artery
Median nerve and its branch: anterior interosseous nerve
Radial nerve
Ulnar nerve
How do you check the hand for features of vascular compromise?
Cool temperature
Pallor
Delayed CRT
Absent pulses
What differentials are there?
Distal humeral fracture
Olecranon fractures
Soft tissue injury
Subluxation of radial head
What investigations are required?
Plain film radiographs: AP and lateral view of elbow
CT may be useful for comminuted fractures
What signs can be seen on plain film?
Posterior fat pad sign
Displacement of anterior humeral line
What should be done in those with associated neurovascular compromise?
Immediate closed reduction
In children this will usually be done in theatre - reduction secured with K wire fixation
Describe the Gartland classification system
Type I - undisplaced
Type II - displaced with intact posterior cortex
type III - displaced in 2 or 3 planes
type IV - displaced with complete periosteal disruption
When can conservative management be trialled?
type I or minimally displaced type II
Managed with an above elbow cast in 90 degree flexion
How are type II, III and IV managed?
Closed reduction and percutaneous K wire fixation
What complications can occur?
Nerve palsies common
Malunion
Volkmann’s contracture
