Supracondylar Humerus Fracture

Question 1

What is the MOI and common population seen with a supracondylar humerus fracture

Answer 1

MOI: FOOSH with elbow extended/hyperextended
Population: young children 5-10
*very dangerous fracture

Question 2

How will the fracture be presented?

Answer 2

1. Distal fragment displaced posteriorly
   *may entrap brachial artery, median and redial nerves
   *entrapment can happen either at injury or reduction

Question 3

What does a supracondylar humerus fracture increase the risk of?

Answer 3

1. Volkmann’s ischemic contracture
   *need to be treated with great care and vigilance

Question 4

What are the symptoms?

Answer 4

1. Swelling
2. Tenderness at the elbow
3. Deformity (prominent olecranon with depression proximally)
   *observe for sin opening, effusion, crepitus, neurovascular checks asses wrist and shoulder

Question 5

What are the diagnostic tests?

Answer 5

1. Elbow radiographs (fat pad sign)
2. CT eval for comminution and joint congruency

Question 6

What are the complications of a supracondylar fracture?

Answer 6

1. Median nerve and brachial artery injury
   *can lead to volkmann ischemic contracture (claw-like deformity from ischemia with flexion contracture of wrist)
2. Radial nerve injury
3. Pain, stiffness, deformity, nonunion

Question 7

What is the treatment of a supracondylar fracture

Answer 7

Stable:
*posterior splint for 10-14 days followed by gentle motion
Unstable/comminution
*ORIF (open reduction internal fraction)
**early motion is the goal

Question 8

What are some of the adverse outcomes and when to refer to ortho?

Answer 8

AO: pain, stiffness, deformity, nonunion, arthritis, neuropathy, infection
Refer: allllllll