Supracondylar Fracture Flashcards
Epidemiology of Supracondylar fractures
Common in children with a peak incidence at 5-7 years
Very rare in adults
Mechanism of injury
FOOSH with elbow in extension
Rarely by landing directly onto a flexed elbow
Common associated injury with supracondylar humeral fractures
Damage to surrounding neurovascular structures
Clinical features
Recent fall or direct trauma
Sudden-onset severe pain + reluctance to move affected arm
Examination findings
Gross deformity
Swelling
Limited range of elbow movement (mainly due to pain)
Ecchymosis of anterior cubital fossa
Other examinations to be done
Neurovascular examination + joint above and below.
What nerves should be examined?
Median nerve
Anterior interosseus nerve
Radial nerve
Ulnar nerve
What vascular examinations should be done?
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
Dx
Distal humeral fracture
Olecranon fracture
(Important to exclude because management will vary)
Soft tissue injury
Subluxation of radial head
Investigations
AP and lateral plain film radiographs.
CT imaging can be useful for comminuted fractures or where intra-articular extension is suspected.
X-ray findings
Posterior fat pad sign (lateral view)
Displacement of the anterior humeral line
What classification system is used in supracondylar fractures?
Gartland classification
Explain Gartland classification
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)
Management can be either conservative or surgical.
What decides which to use?
Type 1 is usually trialled with conservative management.
Also type 2 with minimally displaced fracture can be tried for conservative management.
Explain conservative management.
Above elbow cast in 90 degrees flexion with analgesia