Supracondylar # Of Humerus Flashcards
Age
Childhood
Reason of fracture
Growing bone
Bone is remodelling
Bone is thin in olecranon fossa and coronoid fossa
Bone is less cylindrical
Cancellous bone
Mechanism of injury
Extension type
Fall on out stretched hand with elbow extended
Flexion type
Fall with joint in flexion
Common type
Extension (97 %)
Extension type classification ( gartland )
Type 1 - undisplaced #
Type 2 - angulated #with posterior cortex intact 2a : only angulation
2b : angulation + malrotation
Type 3 - completely displaced # with displacement of distal#
3a = posteromedial
3b = posterolateral
Clinical features
Pain
Swelling
Deformity - s shaped
Restricted movement
Associated vessel injury
Examination
Short arm , normal forearm
Three bony point relation maintained
S shaped deformity
Posterior prominence of tip of olecranon
Xray
Lateral =
Proximal shift
Posterior tilt
Posterior shift
AP=
proximal shift
Medial tilt
Medial or lateral shift
Treatment
Undisplaced #
Immobilisation in above elbow plaster slab with elbow in 90 degree flexion supported by sling
Displaced #
Admit hospital immediately
Displaced #
Closed reduction and k wire fixation( because without k wire the reduction slips )
Open reduction and k wire fixation - if closed reduction failed , open #, vascular damage
Continuous traction - patients who present late with excessive swellling
Can be given by smith traction ( skeletal traction : k wire passed through olecranon )
Dunlop traction ( skin traction )
Closed reduction in sc #
Traction and counter traction with elbow in 30 degree or 40 degree flexion
Elbow gradually extended and forearm in supination
This corrects medial or lateral shift and rotation
Again elbow flexed more than 90 degree if possible
Pressure applied over olecranon with thumb
This cause correction of posterior tilt
Check for pulse and capillary return
What will you do after closed reduction
X ray for confirmation of baumanns angle
If reduction unstable = percutaneous k wire applied
Check circulation every 24 hr
X ray after 1 week to confirm that it hasnt slipped
Spint for 3 weeks - flexion 120 degree with arms pronated
Complication
Early =
Brachial artery injury leading to volksmann ischaemia
Radial ,ulnar , median nerve injury
Late =
Cubitus varus deformity
Elbow stiffness
Myossitis osificans
Volksman ischaemic contracture
cubitus varus deformity
ka gunstock deformity
in this distal fragment is tilted medially and in internal rotation
due to uncorrected angulation , rotation and maybe due to fracture instability after reduction
cubitus varus cause
improper reduction
improper follow up
improper interpretation of radiographs
