Supracondylar Fracture Flashcards

1
Q

Epidemiology of Supracondylar fractures

A

Common in children with a peak incidence at 5-7 years

Very rare in adults

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2
Q

Mechanism of injury

A

FOOSH with elbow in extension

Rarely by landing directly onto a flexed elbow

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3
Q

Common associated injury with supracondylar humeral fractures

A

Damage to surrounding neurovascular structures

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4
Q

Clinical features

A

Recent fall or direct trauma

Sudden-onset severe pain + reluctance to move affected arm

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5
Q

Examination findings

A

Gross deformity

Swelling

Limited range of elbow movement (mainly due to pain)

Ecchymosis of anterior cubital fossa

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6
Q

Other examinations to be done

A

Neurovascular examination + joint above and below.

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7
Q

What nerves should be examined?

A

Median nerve

Anterior interosseus nerve

Radial nerve

Ulnar nerve

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8
Q

What vascular examinations should be done?

A

Check the hand for features of vascular compromise

Are hands cold?

Pallor?

Delayed capillary refill time?

Absent pulses?

Urgent orthopaedic review is required for all supracondylar fractures

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9
Q

Dx

A

Distal humeral fracture

Olecranon fracture

(Important to exclude because management will vary)

Soft tissue injury

Subluxation of radial head

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10
Q

Investigations

A

AP and lateral plain film radiographs.

CT imaging can be useful for comminuted fractures or where intra-articular extension is suspected.

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11
Q

X-ray findings

A

Posterior fat pad sign (lateral view)

Displacement of the anterior humeral line

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12
Q

What classification system is used in supracondylar fractures?

A

Gartland classification

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13
Q

Explain Gartland classification

A

1 - Undisplaced

2 - Displaced with intact posterior cortex

3 - Displaced in two or three planes

4 - Displaced with complete periosteal disruption (can only be diagnosed intra-operatively)

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14
Q

Management can be either conservative or surgical.

What decides which to use?

A

Type 1 is usually trialled with conservative management.

Also type 2 with minimally displaced fracture can be tried for conservative management.

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15
Q

Explain conservative management.

A

Above elbow cast in 90 degrees flexion with analgesia

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16
Q

Indications for surgical management.

A

Neurovascular compromise (needs immediate closed reduction)

Type II, Type III, Type IV nearly always require closed reduction.

Open fracture

17
Q

Explain surgical management.

A

Neurovascular compromise, Type II, III and IV requires closed reduction with percutaneous K-wire fixation

Open fracture should be fixed by open reduction with percutaneous pinning

If closed reduction fails -> Do open reduction

Ongoing vascular compromise not fixed by reduction warrants vascular exploration by vascular surgeon

18
Q

When can K-wire be removed?

A

3-4 weeks after in clinic.

19
Q

Complications

A

Nerve palsies

Malunion

Volkmann’s contracture

20
Q

Nerve palsies in supracondylar fractures

A

Neuropraxia rate is around 10% but rarely result in permanent damage

Anterior interosseous nerve (from median nerve) is most commonly damaged.

Ulnar nerve is also quite common (especially during insertion of medial K-wire)

21
Q

Features of anterior interosseus nerve damage

A

Weakness in the muscle innervated by the AIN including the flexor digitorum profundus muscle to the index (and sometimes the middle) finger, the flexor pollicis longus muscle to the thumb and the pronator quadratus of the distal forearm.

There are no sensory fibres from AIN

22
Q

Malunion in supracondylar fractures

A

More common in fractures managed suboptimally.

Cubitus varus deformity might develop (gunstock)

23
Q

Volkmann’s contracture in supracondylar fracture.

A

Due to vascular compromise (brachial artery) leading to ischaemia and subsequent necrosis of flexor muscle of the forearm.

They will then fibrose and form a contracture

This leads to wrist and hand held in permanent flexion as a claw-like deformity.

24
Q
A